Provider Demographics
NPI:1851658496
Name:LANDRUM, CRYSTAL LEANN (BC-FNP)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEANN
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 7TH ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3375
Mailing Address - Country:US
Mailing Address - Phone:256-355-7665
Mailing Address - Fax:256-686-3214
Practice Address - Street 1:1501 7TH ST SE STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3375
Practice Address - Country:US
Practice Address - Phone:256-355-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL140473Medicaid
AL511-26863OtherBCBS