Provider Demographics
NPI:1598953267
Name:HUNNICUTT, CRYSTAL L (CRNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 37024
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3024
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:1990 HOLTON AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3350
Practice Address - Country:US
Practice Address - Phone:423-523-3111
Practice Address - Fax:423-224-3258
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167545367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00640955Medicare PIN
VA016126W82Medicare PIN