Provider Demographics
NPI:1689163412
Name:PATTERSON, CRYSTAL MOSS (NP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MOSS
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13520 MCLEAREN RD UNIT 711401
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-8059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1541
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN1149363LF0000X
MDR195242363LF0000X
TX1055017363LF0000X
DCRN2026635363LF0000X
VA0024177748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily