Provider Demographics
NPI:1306110168
Name:EVANS, CRYSTAL P
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:P
Last Name:EVANS
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 1:42 WEDGESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4138
Mailing Address - Country:US
Mailing Address - Phone:501-541-8905
Mailing Address - Fax:501-379-8988
Practice Address - Street 1:6323 COLONEL GLENN RD STE 108
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7757
Practice Address - Country:US
Practice Address - Phone:501-569-9092
Practice Address - Fax:501-569-9018
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist