Provider Demographics
NPI:1346419389
Name:CATES, CRYSTAL C (RD)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:C
Last Name:CATES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 REFUGE WAY
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7436
Mailing Address - Country:US
Mailing Address - Phone:843-610-0342
Mailing Address - Fax:
Practice Address - Street 1:2200 CROW LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1663
Practice Address - Country:US
Practice Address - Phone:843-848-5300
Practice Address - Fax:843-848-5345
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
SC234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered