Provider Demographics
NPI:1285901967
Name:LOVELADY, KRYSTAL (FNP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:LOVELADY
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1924 PINE ST
Practice Address - Street 2:SUITE 401C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-670-4080
Practice Address - Fax:325-670-4004
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716566363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology