Provider Demographics
NPI:1336447234
Name:PHAM, CRYSTAL D (CRNA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:PHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:D
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7127
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:2000 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-5610
Practice Address - Country:US
Practice Address - Phone:903-677-1000
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120049367500000X
TX703034367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered