Provider Demographics
NPI:1902478365
Name:O'CONNOR, CRYSTAL (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 PETERS CREEK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4060
Mailing Address - Country:US
Mailing Address - Phone:800-765-7130
Mailing Address - Fax:885-001-8918
Practice Address - Street 1:6701 PETERS CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4060
Practice Address - Country:US
Practice Address - Phone:800-765-7130
Practice Address - Fax:540-438-0023
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty