Provider Demographics
NPI:1508517368
Name:BARDGETT, CRYSTAL LYNN (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:BARDGETT
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3406
Mailing Address - Country:US
Mailing Address - Phone:307-438-0321
Mailing Address - Fax:
Practice Address - Street 1:1743 E YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2246
Practice Address - Country:US
Practice Address - Phone:307-262-8600
Practice Address - Fax:307-205-0494
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY49188364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric