Provider Demographics
NPI:1750880902
Name:CARMODY, CRYSTAL ANN (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:CARMODY
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 1:1303 KINGSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3299
Mailing Address - Country:US
Mailing Address - Phone:303-523-2054
Mailing Address - Fax:
Practice Address - Street 1:12959 S PARKER RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3447
Practice Address - Country:US
Practice Address - Phone:303-523-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993669-NP363L00000X
COAPN0993669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner