Provider Demographics
NPI:1144111543
Name:PARKHURST, CRYSTAL LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CHESTNUT ST LOT 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-2458
Mailing Address - Country:US
Mailing Address - Phone:315-882-0639
Mailing Address - Fax:
Practice Address - Street 1:61 CHESTNUT ST LOT 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-2458
Practice Address - Country:US
Practice Address - Phone:315-882-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY941324-01163W00000X, 163WG0000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice