Individual
KELLEY CHAMP CRUMPLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
4508 MILLS PARK CIR STE 100, COLLEGE STATION, TX 77845-1100
(979) 402-3714
Mailing address
4508 MILLS PARK CIR STE 100, COLLEGE STATION, TX 77845-1100
(979) 402-3714
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
195614
TX
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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