MEDICARE: CRYSTAL T FLAHERTY

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1851998504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL T FLAHERTY

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	NORTHFORK
State	:	WV
Zip	:	24868-0025
Country	:	US
Telephone Number	:	304-862-3433
Fax Number	:

Provider Business Practice Location Address
First Line	:	5293 CHEROKEE RD
Second Line	:
City	:	NORTHFORK
State	:	WV
Zip	:	24868-8103
Country	:	US
Telephone Number	:	304-862-3433
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	01/10/2023

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Directions to “ CRYSTAL T FLAHERTY ” Practice Location

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