Provider Demographics
NPI:1790272607
Name:WATKINS, CRYSTAL (RN, BSN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COOK RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:557 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3809
Practice Address - Country:US
Practice Address - Phone:304-896-5001
Practice Address - Fax:304-752-3436
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66417363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner