Provider Demographics
NPI:1285936500
Name:BAKER, CRYSTAL J (FNP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:JOYCE
Other - Last Name:BAKER-WRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3920A BRIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1117
Mailing Address - Country:US
Mailing Address - Phone:757-983-0351
Mailing Address - Fax:757-510-9041
Practice Address - Street 1:3920A BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1117
Practice Address - Country:US
Practice Address - Phone:757-983-0351
Practice Address - Fax:757-510-9041
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168930363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV4373AMedicare PIN