Provider Demographics
NPI:1740942234
Name:WILSON, CRYSTAL BEARD (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:BEARD
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-5033
Mailing Address - Country:US
Mailing Address - Phone:704-562-5219
Mailing Address - Fax:
Practice Address - Street 1:6127 S NC 16 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037
Practice Address - Country:US
Practice Address - Phone:704-966-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWILS-JY1OC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily