Provider Demographics
NPI:1568824373
Name:FULLER, CRYSTAL ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:FULLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:855-828-0878
Practice Address - Street 1:1613 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5815
Practice Address - Country:US
Practice Address - Phone:915-201-0338
Practice Address - Fax:855-828-0878
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily