Provider Demographics
NPI:1609330273
Name:BUCHANAN, CRYSTAL CHERI (APRN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHERI
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8706
Mailing Address - Country:US
Mailing Address - Phone:270-827-7558
Mailing Address - Fax:270-827-7530
Practice Address - Street 1:47 W WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:SEBREE
Practice Address - State:KY
Practice Address - Zip Code:42455
Practice Address - Country:US
Practice Address - Phone:270-835-7541
Practice Address - Fax:270-835-7802
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100581430Medicaid