Provider Demographics
NPI:1598214629
Name:WOODS, CRYSTAL WEST (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:WEST
Last Name:WOODS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3462
Mailing Address - Country:US
Mailing Address - Phone:276-791-0543
Mailing Address - Fax:
Practice Address - Street 1:924 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3462
Practice Address - Country:US
Practice Address - Phone:276-791-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002868133V00000X
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered