Provider Demographics
NPI:1639780372
Name:HARVEY-REXROAD, CRYSTAL LYNN
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:HARVEY-REXROAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BRUSHY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26833-8627
Mailing Address - Country:US
Mailing Address - Phone:304-703-7942
Mailing Address - Fax:
Practice Address - Street 1:130 SUGARCAMP DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26833-8633
Practice Address - Country:US
Practice Address - Phone:304-749-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-15
Last Update Date:2020-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant