Provider Demographics
NPI:1477865228
Name:ROWELL, CRYSTAL ANN (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:ROWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5127
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN111310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2130102Medicaid
LA2130102Medicaid