Provider Demographics
NPI:1902058753
Name:BATEMON, CHRYSTAL A (MHPP)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:A
Last Name:BATEMON
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2451
Mailing Address - Country:US
Mailing Address - Phone:870-917-2171
Mailing Address - Fax:870-917-2161
Practice Address - Street 1:201 S ROSE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2451
Practice Address - Country:US
Practice Address - Phone:870-917-2171
Practice Address - Fax:870-917-2161
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180635526Medicaid
AR116378726Medicaid