Provider Demographics
NPI:1184961310
Name:DORRIETY, CRYSTAL LEIGH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:DORRIETY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-7889
Mailing Address - Country:US
Mailing Address - Phone:251-327-7422
Mailing Address - Fax:
Practice Address - Street 1:1700 SPRING HILL AVE
Practice Address - Street 2:100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1407
Practice Address - Country:US
Practice Address - Phone:251-435-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily