Provider Demographics
NPI:1649604141
Name:ADAMS, CRYSTAL J (APN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:ADAMS
Suffix:
Gender:F
Credentials:APN
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 1960
Mailing Address - Street 2:PO BOX 497
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-932-8222
Mailing Address - Fax:870-934-3455
Practice Address - Street 1:4901 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8417
Practice Address - Country:US
Practice Address - Phone:870-932-8222
Practice Address - Fax:870-934-3455
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198817758Medicaid
AR198817758Medicaid