Provider Demographics
NPI:1174284251
Name:ALBERY, CRYSTAL DAWN
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DAWN
Last Name:ALBERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2415
Mailing Address - Country:US
Mailing Address - Phone:336-936-8168
Mailing Address - Fax:336-753-8150
Practice Address - Street 1:66 COURT SQ
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2415
Practice Address - Country:US
Practice Address - Phone:336-936-8168
Practice Address - Fax:336-753-8150
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6405372500000X, 385H00000X, 374U00000X, 376J00000X, 372600000X
NC372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No385H00000XRespite Care FacilityRespite Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker