Provider Demographics
NPI:1073816476
Name:KELLY, CRYSTAL JOY (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOY
Last Name:KELLY
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 HOWARDS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7530
Mailing Address - Country:US
Mailing Address - Phone:828-265-1317
Mailing Address - Fax:
Practice Address - Street 1:3464 HOWARDS CREEK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7530
Practice Address - Country:US
Practice Address - Phone:828-265-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula