Provider Demographics
NPI:1891353561
Name:TRUMP, KRYSTAL NICHOLE (DO)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NICHOLE
Last Name:TRUMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 PLEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8720
Mailing Address - Country:US
Mailing Address - Phone:540-689-5500
Mailing Address - Fax:757-431-7116
Practice Address - Street 1:2509 PLEASANT RUN DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8720
Practice Address - Country:US
Practice Address - Phone:540-689-5500
Practice Address - Fax:757-431-7116
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207779207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine