Provider Demographics
NPI:1861014151
Name:RHOADES, CHRYSTAL LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:LYNN
Last Name:RHOADES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 DONERAIL DR SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8516
Mailing Address - Country:US
Mailing Address - Phone:614-329-5125
Mailing Address - Fax:
Practice Address - Street 1:353 DONERAIL DR SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8516
Practice Address - Country:US
Practice Address - Phone:614-329-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily