Provider Demographics
NPI:1295168961
Name:BUCK, CRYSTAL ROSE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ROSE
Last Name:BUCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1916
Mailing Address - Country:US
Mailing Address - Phone:434-390-7224
Mailing Address - Fax:
Practice Address - Street 1:45 MARKETPLACE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6516
Practice Address - Country:US
Practice Address - Phone:540-483-3678
Practice Address - Fax:540-483-3820
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05545OtherMEDICARE GROUP PTAN