Provider Demographics
NPI:1225538887
Name:NORTH, CRISTAL SHAVON (CRNA)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:SHAVON
Last Name:NORTH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRISTAL
Other - Middle Name:SHAVON
Other - Last Name:SCOTT-NORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:6501 FANNIN ST STE NC114
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-798-7356
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:823-355-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX382475701Medicaid
TX382475702OtherCSHCN TPI