Provider Demographics
NPI:1548754211
Name:CLOY, CRYSTAL ALANE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ALANE
Last Name:CLOY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 TANNAHILL ST
Mailing Address - Street 2:
Mailing Address - City:WESSON
Mailing Address - State:MS
Mailing Address - Zip Code:39191-9021
Mailing Address - Country:US
Mailing Address - Phone:601-320-3208
Mailing Address - Fax:
Practice Address - Street 1:436 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2938
Practice Address - Country:US
Practice Address - Phone:601-835-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSWILL-JTD9SO2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry