Provider Demographics
NPI:1174273445
Name:KANIPE, CRYSTAL NICOLE (NP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:KANIPE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 CREEKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6082
Mailing Address - Country:US
Mailing Address - Phone:919-452-0260
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL PARK STE B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2580
Practice Address - Country:US
Practice Address - Phone:919-693-1082
Practice Address - Fax:919-693-2726
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09210289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily