Clark, Crystal B
Clark, Crystal B is an individual health care provider with primary practice located at 885 Gold Hill Rd # 1003 , Fort Mill SC 29708-7946. She recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Clark, Crystal B can be contacted via phone (803) 288-9495.Contact Information
Primary practice address
885 Gold Hill Rd # 1003
Fort Mill SC 29708-7946
Phone: (803) 288-9495
Fax: (989) 214-7326
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 22378 | South Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 22378 | South Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 22378 | South Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 22378 | South Carolina |
Profile Details
| NPI number | 1154898179 |
|---|---|
| LBN Legal business name | Clark, Crystal B |
| Credentials | FNP-C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 29th, 2018 |
| Last updated | Jun 8th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154898179 | NPPES |
| South Carolina | MEDICAID | NP5853 | |
| South Carolina | Other | 22378 | |
| South Carolina | Other | 5422378 |
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