Provider Demographics
NPI:1710528914
Name:WILLIAMS, CRYSTAL CHE (DNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CHE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 AIKEN TER
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2003
Mailing Address - Country:US
Mailing Address - Phone:352-219-3405
Mailing Address - Fax:
Practice Address - Street 1:1251 LEWIS RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9203
Practice Address - Country:US
Practice Address - Phone:360-225-4310
Practice Address - Fax:360-225-4339
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61005850363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2143467Medicaid