Provider Demographics
NPI:1720552763
Name:HAYES, CRYSTAL SMITH
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:SMITH
Last Name:HAYES
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 1:924 WHEELWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2640
Mailing Address - Country:US
Mailing Address - Phone:804-366-0039
Mailing Address - Fax:
Practice Address - Street 1:924 WHEELWOOD WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2640
Practice Address - Country:US
Practice Address - Phone:804-366-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT65428405172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver