Provider Demographics
NPI:1487359428
Name:WHITE, CRYSTAL MICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:MICHELLE
Other - Last Name:GIDCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:589 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3414
Mailing Address - Country:US
Mailing Address - Phone:629-255-0516
Mailing Address - Fax:615-883-2451
Practice Address - Street 1:589 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3414
Practice Address - Country:US
Practice Address - Phone:629-255-0516
Practice Address - Fax:615-883-2451
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51668164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse