Provider Demographics
NPI:1811527492
Name:ALLEN, CRYSTAL (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CRISTIE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 HOSPITAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7343
Mailing Address - Country:US
Mailing Address - Phone:870-793-7519
Mailing Address - Fax:
Practice Address - Street 1:16 HOSPITAL CIR STE A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7343
Practice Address - Country:US
Practice Address - Phone:870-793-7519
Practice Address - Fax:870-793-8146
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR095526163W00000X
AR123697363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123697OtherAPRN LICENSE