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Contact Information

CRYSTALCARE
3124 N SHILOH ROAD
CORINTH, MS38834
 Phone: 901-292-2964
 Fax: 662-762-0690
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for CRYSTALCARE

NPI # 1477176824
LBN Legal business name CRYSTALCARE
Authorized official CRYSTAL WILSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/20/2020
Last updated 11/18/2020 - About 6 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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