Provider Demographics
NPI:1285178897
Name:BLEVINS, CRYSTAL (CDCA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 RARDEN RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-1075
Mailing Address - Country:US
Mailing Address - Phone:740-981-4588
Mailing Address - Fax:
Practice Address - Street 1:256 RARDEN RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-1075
Practice Address - Country:US
Practice Address - Phone:937-752-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2022-12-28
Deactivation Date:2022-12-21
Deactivation Code:
Reactivation Date:2022-12-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant