Provider Demographics
NPI:1588929913
Name:MICHEALSON, CRYSTAL (PA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MICHEALSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:ARROYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4323 INTEGRITY CENTER PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1683
Mailing Address - Country:US
Mailing Address - Phone:719-364-9560
Mailing Address - Fax:
Practice Address - Street 1:4323 INTEGRITY CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1683
Practice Address - Country:US
Practice Address - Phone:719-364-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant