Provider Demographics
NPI:1871246215
Name:MARTIN, CRYSTAL LYNN (AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 LONESOME OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-9531
Mailing Address - Country:US
Mailing Address - Phone:336-583-5681
Mailing Address - Fax:
Practice Address - Street 1:783 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4571
Practice Address - Country:US
Practice Address - Phone:336-599-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMART-VWNGJ363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty