Provider Demographics
NPI:1043701865
Name:CROSBY, CHARI LYNN (RN, CST)
Entity Type:Individual
Prefix:
First Name:CHARI
Middle Name:LYNN
Last Name:CROSBY
Suffix:
Gender:F
Credentials:RN, CST
Other - Prefix:
Other - First Name:CHARI
Other - Middle Name:LYNN
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:307 POKER CHIP UNIT 113
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BAY
Mailing Address - State:TX
Mailing Address - Zip Code:78657-6084
Mailing Address - Country:US
Mailing Address - Phone:512-592-2698
Mailing Address - Fax:
Practice Address - Street 1:307 POKER CHIP UNIT 113
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-6084
Practice Address - Country:US
Practice Address - Phone:512-592-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX891288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse