Provider Demographics
NPI:1437792116
Name:KRYSTYN, SARA CARROLL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:CARROLL
Last Name:KRYSTYN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST STE 24
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1312
Mailing Address - Country:US
Mailing Address - Phone:334-793-1534
Mailing Address - Fax:334-793-6840
Practice Address - Street 1:4300 W MAIN ST STE 24
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1312
Practice Address - Country:US
Practice Address - Phone:334-806-6807
Practice Address - Fax:334-793-6840
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145051163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse