Provider Demographics
NPI:1952695298
Name:CARTER, CRYSTAL DEE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9299
Mailing Address - Country:US
Mailing Address - Phone:307-587-5112
Mailing Address - Fax:307-587-5446
Practice Address - Street 1:2713 COUGAR AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8400
Practice Address - Country:US
Practice Address - Phone:307-587-5112
Practice Address - Fax:307-587-5446
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYRN 9137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse