Provider Demographics
NPI:1922690247
Name:WEATHERFORD, CRYSTAL CHEYENNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CHEYENNE
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CHEYENNE
Other - Last Name:COUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51748 HOPI ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1358
Mailing Address - Country:US
Mailing Address - Phone:214-476-0188
Mailing Address - Fax:
Practice Address - Street 1:2305 BIRDCREEK TER
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1047
Practice Address - Country:US
Practice Address - Phone:254-771-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018430163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse