Provider Demographics
NPI:1285340034
Name:CARRIERE ROBINSON, CRYSTAL S
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:CARRIERE ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 BINGMAN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-5913
Mailing Address - Country:US
Mailing Address - Phone:409-225-1209
Mailing Address - Fax:
Practice Address - Street 1:1890 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1937
Practice Address - Country:US
Practice Address - Phone:409-229-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X, 343800000X
TX310620373H00000X
TX0229443747A0650X, 385HR2060X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No343800000XTransportation ServicesSecured Medical Transport (VAN)