Provider Demographics
NPI:1275869950
Name:MARTIN, CRYSTAL HOWELL (C-FNP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:HOWELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:LEIGH
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4134 HIGHWAY 471
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8626
Mailing Address - Country:US
Mailing Address - Phone:601-405-3100
Mailing Address - Fax:
Practice Address - Street 1:407 S VALLEY ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4051
Practice Address - Country:US
Practice Address - Phone:601-298-0333
Practice Address - Fax:601-298-0797
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily