Provider Demographics
NPI:1417845926
Name:KNOTTS, CRYSTAL VIRGINIA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VIRGINIA
Last Name:KNOTTS
Suffix:
Gender:X
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 286
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:WV
Mailing Address - Zip Code:26435-0286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 KNOTTS DR
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26347
Practice Address - Country:US
Practice Address - Phone:304-476-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide