Provider Demographics
NPI:1568038552
Name:LOVETT, CRYSTAL D (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:LOVETT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1917
Mailing Address - Country:US
Mailing Address - Phone:304-982-1495
Mailing Address - Fax:
Practice Address - Street 1:925 GLEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1917
Practice Address - Country:US
Practice Address - Phone:304-982-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WV83613163WL0100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse