Provider Demographics
NPI:1568667384
Name:COOLEY, CRYSTAL J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:J
Last Name:COOLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:HARRIET
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:13 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1205
Mailing Address - Country:US
Mailing Address - Phone:864-255-1000
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3955
Practice Address - Country:US
Practice Address - Phone:864-255-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30210120OtherFIRSTCHOICE, SELECT HEALTH
SCNPI #OtherBLUE CHOICE COMMERCIAL PLANS
SCNPI #OtherBLUE CROSS NETWORKS
SC1068772OtherWELLCARE
SCNPI #OtherTRICARE SOUTH REGION
SCNPI #OtherBLUE CHOICE MEDICAID
GA003159119AMedicaid
SCAN1402Medicaid
SCQ339031153Medicare PIN