Provider Demographics
NPI:1689149973
Name:THOMAS, CRYSTAL CHIVON (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHIVON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 VILLAGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4648
Mailing Address - Country:US
Mailing Address - Phone:972-423-2733
Mailing Address - Fax:972-516-3971
Practice Address - Street 1:3661 N PLANO RD STE 3000
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2029
Practice Address - Country:US
Practice Address - Phone:972-238-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily