Provider Demographics
NPI:1912565698
Name:CRESPO, DIONNA
Entity type:Individual
Prefix:
First Name:DIONNA
Middle Name:
Last Name:CRESPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8775
Mailing Address - Country:US
Mailing Address - Phone:860-494-6105
Mailing Address - Fax:228-203-3821
Practice Address - Street 1:770 WATER ST STE 487
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4220
Practice Address - Country:US
Practice Address - Phone:228-215-5030
Practice Address - Fax:228-203-3821
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903240363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health