Provider Demographics
NPI:1366982944
Name:FRUTCHEY, CRYSTAL ANN (PA-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:FRUTCHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 IVEY LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINEURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9817
Mailing Address - Country:US
Mailing Address - Phone:910-215-5210
Mailing Address - Fax:910-215-5215
Practice Address - Street 1:150 IVEY LANE
Practice Address - Street 2:SUITE B
Practice Address - City:PINEURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9817
Practice Address - Country:US
Practice Address - Phone:910-215-5210
Practice Address - Fax:910-215-5215
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant