MEDICARE: CRYSTAL DOWELL FNP

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	363LF0000X	Family Nurse Practitioner	AP129272	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1598136418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL DOWELL FNP

Provider Business Mailing Address
First Line	:	1507 W MAIN ST
Second Line	:
City	:	GATESVILLE
State	:	TX
Zip	:	76528-1024
Country	:	US
Telephone Number	:	254-865-2166
Fax Number	:	254-248-6306

Provider Business Practice Location Address
First Line	:	1510 HANNA VALLEY RD
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2533
Country	:	US
Telephone Number	:	325-648-2263
Fax Number	:	325-648-6303

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

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	07/31/2023

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