Provider Demographics
NPI:1073165148
Name:GAMMON, CHRYSTAL (NP)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:GAMMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27342-0045
Mailing Address - Country:US
Mailing Address - Phone:434-429-2383
Mailing Address - Fax:
Practice Address - Street 1:906 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5757
Practice Address - Country:US
Practice Address - Phone:336-935-1240
Practice Address - Fax:336-234-1020
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012088363LC1500X, 363LF0000X
VA0024177827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health