Provider Demographics
NPI:1093289571
Name:SMITH, CRYSTAL FREEMAN (FNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:FREEMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SPRINGHILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-7044
Mailing Address - Country:US
Mailing Address - Phone:910-995-3512
Mailing Address - Fax:
Practice Address - Street 1:211 BONNIE BROOK RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3125
Practice Address - Country:US
Practice Address - Phone:910-716-0099
Practice Address - Fax:910-405-1359
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE