Provider Demographics
NPI:1538631932
Name:EALY, CRYSTAL LASHAWN (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LASHAWN
Last Name:EALY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8939
Mailing Address - Country:US
Mailing Address - Phone:804-605-0183
Mailing Address - Fax:
Practice Address - Street 1:13540 E BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3943
Practice Address - Country:US
Practice Address - Phone:804-605-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-23
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty