Provider Demographics
NPI:1144648460
Name:NELSON, CRYSTAL RENEE (MSED, ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 COLLEGE DR
Mailing Address - Street 2:BOX 563
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71359-1000
Mailing Address - Country:US
Mailing Address - Phone:318-487-7792
Mailing Address - Fax:
Practice Address - Street 1:1140 COLLEGE DR
Practice Address - Street 2:BOX 563
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71359-1000
Practice Address - Country:US
Practice Address - Phone:318-487-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2001632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer