Provider Demographics
NPI:1750870846
Name:ASHBURN, CRYSTAL LYN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYN
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LYN
Other - Last Name:TRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5514 CORPORATE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7763
Mailing Address - Country:US
Mailing Address - Phone:816-271-1221
Mailing Address - Fax:816-279-7749
Practice Address - Street 1:5514 CORPORATE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7754
Practice Address - Country:US
Practice Address - Phone:816-271-1221
Practice Address - Fax:816-279-7794
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily