Provider Demographics
NPI:1558106294
Name:SMITH, CHRYSTAL FELICIA (CNA, PBT(ASCP))
Entity type:Individual
Prefix:MS
First Name:CHRYSTAL
Middle Name:FELICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA, PBT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SALEM STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302
Mailing Address - Country:US
Mailing Address - Phone:864-278-5692
Mailing Address - Fax:864-658-4457
Practice Address - Street 1:110 SALEM STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302
Practice Address - Country:US
Practice Address - Phone:864-278-5692
Practice Address - Fax:864-658-4457
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45313246RP1900X
SC165499376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy