Provider Demographics
NPI:1992331573
Name:SMITH, KRYSTAL NICOLE (PMHNP, FNP, CRNP)
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP, FNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 GOVERNMENT BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4310
Mailing Address - Country:US
Mailing Address - Phone:251-300-7134
Mailing Address - Fax:251-202-7851
Practice Address - Street 1:3737 GOVERNMENT BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4310
Practice Address - Country:US
Practice Address - Phone:251-300-7134
Practice Address - Fax:251-202-7851
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-146984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health