Provider Demographics
NPI:1356749808
Name:CAUGHY, CRYSTAL LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:CAUGHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:ZELINSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 ASHMUN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1972
Mailing Address - Country:US
Mailing Address - Phone:906-632-3013
Mailing Address - Fax:906-632-8618
Practice Address - Street 1:510 ASHMUN ST STE 5
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1972
Practice Address - Country:US
Practice Address - Phone:906-632-6013
Practice Address - Fax:906-632-8618
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005601363A00000X
MI5601010834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant