Provider Demographics
NPI:1770962532
Name:KIRKLAND, CRYSTAL LEANN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEANN
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:LEANN
Other - Last Name:SOUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4215 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2421
Mailing Address - Country:US
Mailing Address - Phone:253-792-6651
Mailing Address - Fax:
Practice Address - Street 1:4215 49TH AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-2421
Practice Address - Country:US
Practice Address - Phone:253-792-6651
Practice Address - Fax:253-942-3486
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61630988363LF0000X
TN20030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily