Provider Demographics
NPI:1487861522
Name:LEEPER, CRYSTAL L
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:L
Last Name:LEEPER
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 1:9210 TALL TIMBER BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8523
Mailing Address - Country:US
Mailing Address - Phone:870-245-8485
Mailing Address - Fax:
Practice Address - Street 1:9210 TALL TIMBER BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8523
Practice Address - Country:US
Practice Address - Phone:870-245-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist