Provider Demographics
NPI:1376156448
Name:GOODWIN, CRYSTAL ELIZABETH
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:TALCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:24981-0245
Mailing Address - Country:US
Mailing Address - Phone:304-250-8019
Mailing Address - Fax:
Practice Address - Street 1:38 PENNY LN
Practice Address - Street 2:
Practice Address - City:TALCOTT
Practice Address - State:WV
Practice Address - Zip Code:24981
Practice Address - Country:US
Practice Address - Phone:304-250-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant