Provider Demographics
NPI:1285440982
Name:MATTHEWS, CRYSTAL T (CNA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:T
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 STARLET DRVIE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2249
Mailing Address - Country:US
Mailing Address - Phone:314-356-6883
Mailing Address - Fax:
Practice Address - Street 1:765 STARLET DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2249
Practice Address - Country:US
Practice Address - Phone:314-356-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO90928A376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide