Provider Demographics
NPI:1528896677
Name:FIRMIN, CRYSTAL G (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:G
Last Name:FIRMIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SYCAMORE ST STE B
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3403
Mailing Address - Country:US
Mailing Address - Phone:800-462-0742
Mailing Address - Fax:318-717-1826
Practice Address - Street 1:417 N MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:SIMMESPORT
Practice Address - State:LA
Practice Address - Zip Code:71369-2181
Practice Address - Country:US
Practice Address - Phone:800-462-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily