Provider Demographics
NPI:1063494045
Name:BROWN, CRYSTAL D (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 METKER TRL
Mailing Address - Street 2:STE A
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1049
Mailing Address - Country:US
Mailing Address - Phone:606-365-8338
Mailing Address - Fax:606-365-8142
Practice Address - Street 1:107 METKER TRL
Practice Address - Street 2:STE A
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1049
Practice Address - Country:US
Practice Address - Phone:606-365-8338
Practice Address - Fax:606-365-8142
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1841P363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000046065OtherBS
7528229OtherAETNA
KY1841POtherLICENSE
KY78000684Medicaid
7528229OtherAETNA