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NPI Code Detail

MEDICARE: CRYSTAL Y CLARK-CROOKSHANKS FNP

MEDICARE: CRYSTAL Y CLARK-CROOKSHANKS 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
1363LF0000XFamily Nurse Practitioner63168WV
2363LP2300XPrimary Care Nurse PractitionerAPRN63168WV

General Provider Information

NPI Number : 1942567763
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL Y CLARK-CROOKSHANKS FNP
Provider Business Mailing Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number : 888-736-3229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2012
Last Update Date : 07/17/2024

Similar Medicare Providers

1104986835 — MARCIE L VAUGHAN
Practice Location Address:
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1407028418 — SENECA HEALTH SERVICES, INC.
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1851643597 — JESSICA G SHIELER LSW
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1992363253 — ZACHARY SMITH
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1609401520 — RACHEL RICHARDSON APRN, PMHNP-BC
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Directions to “ CRYSTAL Y CLARK-CROOKSHANKS FNP” Practice Location

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