Provider Demographics
NPI:1619761558
Name:TERRY, CRYSTAL (DNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:UT
Mailing Address - Zip Code:84340-0161
Mailing Address - Country:US
Mailing Address - Phone:435-287-5092
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 161
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:UT
Practice Address - Zip Code:84340-0161
Practice Address - Country:US
Practice Address - Phone:435-287-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9806366-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner