Provider Demographics
NPI:1669979423
Name:TIMMS, CRYSTAL DENAE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENAE
Last Name:TIMMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-7930
Mailing Address - Country:US
Mailing Address - Phone:405-402-9119
Mailing Address - Fax:
Practice Address - Street 1:109 SKYLANE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-7930
Practice Address - Country:US
Practice Address - Phone:405-613-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist