Provider Demographics
NPI:1760872550
Name:CHERAPAN, KRYSTAL GAYLE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:GAYLE
Last Name:CHERAPAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6328 E BROWN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4841
Mailing Address - Country:US
Mailing Address - Phone:480-654-3303
Mailing Address - Fax:480-654-4030
Practice Address - Street 1:6328 E BROWN RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4841
Practice Address - Country:US
Practice Address - Phone:480-654-3303
Practice Address - Fax:480-654-4030
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7582207R00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty