Provider Demographics
NPI:1770119695
Name:RAYTON, CRYSTAL WYLENA (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:WYLENA
Last Name:RAYTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 S LEE ST STE 101&102
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3710
Mailing Address - Country:US
Mailing Address - Phone:678-765-8160
Mailing Address - Fax:678-765-8163
Practice Address - Street 1:4271 S LEE ST # 101102
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3710
Practice Address - Country:US
Practice Address - Phone:678-765-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN087149164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse