Provider Demographics
NPI:1790999480
Name:CRUMBY, CHARLENE (RN MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:CRUMBY
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5012 S US HWY 75, SUITE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6430
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 250
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6430
Practice Address - Fax:903-416-6431
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231525363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330235801Medicaid
TX330721YMCMMedicare PIN