Provider Demographics
NPI:1376357673
Name:PEYATT, CRYSTAL LEE (CNA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:PEYATT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:NE
Mailing Address - Zip Code:68714-5046
Mailing Address - Country:US
Mailing Address - Phone:402-760-1651
Mailing Address - Fax:
Practice Address - Street 1:110 N WESTERN ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1743
Practice Address - Country:US
Practice Address - Phone:402-376-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE151994374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide