Provider Demographics
NPI:1528176088
Name:MARK, CRYSTAL A (FNP, DC)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:A
Last Name:MARK
Suffix:
Gender:F
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27130 GLEN LOCH DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381
Mailing Address - Country:US
Mailing Address - Phone:281-292-0808
Mailing Address - Fax:888-578-2659
Practice Address - Street 1:27130 GLEN LOCH DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381
Practice Address - Country:US
Practice Address - Phone:281-292-0808
Practice Address - Fax:888-578-2659
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8310111N00000X
TXAP137953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609428Medicare ID - Type Unspecified