Provider Demographics
NPI:1881137024
Name:BRABBLE, CRYSTAL DAVENPORT (FNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAVENPORT
Last Name:BRABBLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:D
Other - Last Name:BRABBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1177 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3388
Mailing Address - Country:US
Mailing Address - Phone:252-337-9440
Mailing Address - Fax:252-384-9997
Practice Address - Street 1:1177 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3388
Practice Address - Country:US
Practice Address - Phone:252-337-9440
Practice Address - Fax:252-384-9997
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009106363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner