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Organization
KRYSTAL FAMILY CLINIC LLC
Active
Organization
KRYSTAL FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEYNA OMENUKOR NP (CEO)
(972) 576-7399
Entity
Organization
Contact information
Practice address
1675 REPUBLIC PKWY STE 101, MESQUITE, TX 75150-6902
(972) 576-7399
(972) 476-0006
Mailing address
1675 REPUBLIC PKWY STE 100, MESQUITE, TX 75150-6902
(972) 576-7399
(972) 476-0006
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/22/2017
Last updated
07/21/2022
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