Provider Demographics
NPI:1154323145
Name:HAMMOND, CRYSTAL R (APRN-CNM, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:APRN-CNM, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9020
Mailing Address - Country:US
Mailing Address - Phone:937-964-1268
Mailing Address - Fax:
Practice Address - Street 1:1108 VESTER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1302
Practice Address - Country:US
Practice Address - Phone:937-399-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP020368363LF0000X
OHAPRNCNM03296367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329933Medicaid
OH0329933Medicaid
OH000000259061OtherANTHEM
OHS34420Medicare UPIN
OHNM00502Medicare ID - Type UnspecifiedMEDICARE