Provider Demographics
NPI:1104485010
Name:WARD, CRYSTAL AMANDA (FNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:AMANDA
Last Name:WARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59101 AMBER ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3708
Mailing Address - Country:US
Mailing Address - Phone:985-646-1580
Mailing Address - Fax:888-863-4274
Practice Address - Street 1:8250 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1612
Practice Address - Country:US
Practice Address - Phone:504-279-5547
Practice Address - Fax:844-877-1859
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily