Provider Demographics
NPI:1578524070
Name:LUFFMAN, CRYSTAL BLEVINS (APRN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:BLEVINS
Last Name:LUFFMAN
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:R
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4124 MINING RIDGE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STATE ROAD
Mailing Address - State:NC
Mailing Address - Zip Code:28676-9170
Mailing Address - Country:US
Mailing Address - Phone:364-673-5553
Mailing Address - Fax:
Practice Address - Street 1:690 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2487
Practice Address - Country:US
Practice Address - Phone:336-526-2619
Practice Address - Fax:336-526-5967
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189513163W00000X
NC5015871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse