Provider Demographics
NPI:1801346259
Name:WHITEHOUSE, CRYSTAL (APRN-NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22618
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-2618
Mailing Address - Country:US
Mailing Address - Phone:270-574-5600
Mailing Address - Fax:270-574-5609
Practice Address - Street 1:920 FREDERICA ST STE 204
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3077
Practice Address - Country:US
Practice Address - Phone:270-574-5600
Practice Address - Fax:270-574-5609
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100425010Medicaid