Provider Demographics
NPI:1417262023
Name:KING, CRYSTAL M (ANP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 CROUSE LN STE E
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8317
Mailing Address - Country:US
Mailing Address - Phone:336-567-4033
Mailing Address - Fax:800-418-5873
Practice Address - Street 1:2929 CROUSE LN STE E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8317
Practice Address - Country:US
Practice Address - Phone:336-266-0334
Practice Address - Fax:800-418-5873
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417262023Medicaid
NCD188D123OtherMEDICARE