Individual
CRYSTAL NICOLE BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-NP
Contact information
Practice address
8111 BARDSTOWN RD, LOUISVILLE, KY 40291-3441
(502) 231-7680
(502) 231-8149
Mailing address
100 E LIBERTY ST, SUITE 800, LOUISVILLE, KY 40202-1434
(502) 231-7680
(502) 231-8149
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3009368
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100382320 (KOHMG)
—
KY
Enumeration date
04/29/2015
Last updated
06/10/2020
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