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NPI Code Detail

MEDICARE: CRYSTAL PREWITT APRN

MEDICARE: CRYSTAL PREWITT APRN
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
1363L00000XNurse Practitioner3005650KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000601702OTHERKYANTHEM

General Provider Information

NPI Number : 1588813083
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL PREWITT APRN
Provider Business Mailing Address
First Line : 140 BRYAN BLVD
Second Line :
City : CORBIN
State : KY
Zip : 40701-2775
Country : US
Telephone Number : 606-523-2005
Fax Number : 606-523-9704
Provider Business Practice Location Address
First Line : 140 BRYAN BLVD
Second Line :
City : CORBIN
State : KY
Zip : 40701-2775
Country : US
Telephone Number : 606-523-2005
Fax Number : 606-523-9704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2008
Last Update Date : 11/07/2018

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Directions to “ CRYSTAL PREWITT APRN” Practice Location

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