| A Crystal Mind | |
|
4015 Executive Park Dr Ste 310 Cincinnati OH 45241-4015 | |
| (513) 923-6336 | |
| (562) 261-1296 |
| Full Name | A Crystal Mind |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4015 Executive Park Dr Ste 310, Cincinnati, Ohio |
| Authorized Official Name and Position | Crystal Farrell (OWNER) |
| Authorized Official Contact | 5139236336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Crystal Mind Po Box 1441 West Chester OH 45071-1441 Ph: (513) 923-6336 | A Crystal Mind 4015 Executive Park Dr Ste 310 Cincinnati OH 45241-4015 Ph: (513) 923-6336 |
| NPI Number | 1467068262 |
|---|---|
| Provider Enumeration Date | 09/17/2020 |
| Last Update Date | 01/16/2021 |
| Certification Date | 01/16/2021 |
| Medicare PECOS PAC ID | 6204255565 |
|---|---|
| Medicare Enrollment ID | O20201006001598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467068262 | NPI | - | NPPES |
| Provider Name | Crystal Jr Farrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386864619 PECOS PAC ID: 5799917886 Enrollment ID: I20181001000803 |
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