Provider Demographics
NPI:1275032153
Name:IMASOGIE, CRYSTAL (FNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:IMASOGIE
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 1:7723 POUTER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5131
Mailing Address - Country:US
Mailing Address - Phone:281-777-8736
Mailing Address - Fax:
Practice Address - Street 1:16605 SOUTHWEST FWY STE 175
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-0003
Practice Address - Country:US
Practice Address - Phone:281-302-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134361363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner