MEDICARE: MS. CRYSTAL BLEVINS LUFFMAN APRN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	189513	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5015871	NC

General Provider Information

NPI Number	:	1578524070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL BLEVINS LUFFMAN APRN, PMHNP

Provider Business Mailing Address
First Line	:	4124 MINING RIDGE CHURCH RD
Second Line	:
City	:	STATE ROAD
State	:	NC
Zip	:	28676-9170
Country	:	US
Telephone Number	:	364-673-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2487
Country	:	US
Telephone Number	:	336-526-2619
Fax Number	:	336-526-5967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	03/02/2022

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