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Individual
MISS CRYSTAL B CLARK
Active
Individual
MISS CRYSTAL B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22378
SC
363LF0000X
Family Nurse Practitioner
22378
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22378
APRN LICENSURE
SC
01
—
5422378
CONTROLLED SUBSTANCE LICENSURE
SC
05
—
NP5853
—
SC
Enumeration date
10/29/2018
Last updated
07/23/2026
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