Provider Demographics
NPI:1518328624
Name:STONE, CRYSTAL (APRN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1214
Mailing Address - Country:US
Mailing Address - Phone:618-416-7738
Mailing Address - Fax:877-295-7244
Practice Address - Street 1:423 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1214
Practice Address - Country:US
Practice Address - Phone:618-416-7738
Practice Address - Fax:877-295-7244
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000091363LF0000X
MO2016008570363LF0000X
IL277.000091363LP0808X
IL209014122363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health