Provider Demographics
NPI:1669601555
Name:MONIGOLD, CHRYSTAL JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:JEAN
Last Name:MONIGOLD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9012
Mailing Address - Country:US
Mailing Address - Phone:580-510-0077
Mailing Address - Fax:580-510-2751
Practice Address - Street 1:1602 SW 82ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9012
Practice Address - Country:US
Practice Address - Phone:580-510-0077
Practice Address - Fax:580-510-2751
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily