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Individual
CRYSTAL ANTWANETTE KINGCADE
Active
Individual
CRYSTAL ANTWANETTE KINGCADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21587
SC
363LF0000X
Family Nurse Practitioner
21587
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024189346
VA
Other
Enumeration date
02/07/2018
Last updated
09/18/2024
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