Provider Demographics
NPI:1720343130
Name:TAWNEY, KRYSTAL DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DAWN
Last Name:TAWNEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SKYLAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9383
Mailing Address - Country:US
Mailing Address - Phone:304-645-3435
Mailing Address - Fax:043-645-3463
Practice Address - Street 1:226 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9383
Practice Address - Country:US
Practice Address - Phone:304-645-3435
Practice Address - Fax:304-645-3463
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012420363LF0000X
WV75957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102780235Medicaid
WV3810024409Medicaid
PA260754Medicare PIN
PA102780235Medicaid