KRYSTAL FAMILY CLINIC LLC (NPI# 1811424708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811424708 |
| Entity Type | Organization |
| Organization Name | KRYSTAL FAMILY CLINIC LLC |
| Practice Address |
1675 Republic Pkwy Ste 101 Mesquite TX 75150-6902 |
| Practice Telephone | (972) 576-7399 |
| Practice Fax Number | 9724760006 |
| Mailing Telephone | 9725767399 |
| Mailing Fax Number | 9724760006 |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2017-05-22 |
| Authorized Official Name | KEYNA OMENUKOR (CEO) |
| Authorized Official Telephone | 9725767399 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1675 REPUBLIC PKWY STE 101 |
| City | MESQUITE |
| State | TX |
| Zip Code | 75150-6902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992003016 | Martin Jackson Dpm Psc | Podiatrist | 1675 Republic Pkwy Ste 101, Mesquite, TX 75150-6902 | 2011-03-14 |
| 1407410509 | Interventional Partners, LLC | Podiatrist | 1675 Republic Pkwy Ste 101, Mesquite, TX 75150-6902 | 2019-04-24 |
| 1760968358 | Paul Britt | Chiropractor | 1675 Republic Pkwy Ste 101, Mesquite, TX 75150-6902 | 2018-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124630991 | Affordable Home Health Care | Home Health | 3637 E. Us. Highway 80, Mesquite, TX 75150 | 2020-08-21 |
| 1245840933 | Shanikqu Lashun George | Specialist | 1515 N. Towneast Blvd., Suite 19, Mesquite, TX 75150 | 2020-08-06 |
| 1578109542 | Phyllis Renee Cephas | Counselor | 2200 N. Belt Line Road, #728, Mesquite, TX 75150 | 2019-11-25 |
| 1033766068 | Darryl E Richmond Jr. | Physical Therapist | 2578 N Galloway Ave, 100, Mesquite, TX 75150 | 2019-08-23 |
| 1922666916 | Jd Mesquite Dental Pllc | Dentist | 909 Tripp Rd Ste 190, Mesquite, TX 75150 | 2019-06-04 |
| 1134681349 | Champions Rehabilitation, LLC | Clinic/Center | 1675 Republic Parkway Suite 201, Mesquite, TX 75150 | 2019-04-05 |
| 1205317351 | Sheila Katherine Bartley | Occupational Therapist | 3617 O'hare Dr., Mesquite, TX 75150 | 2018-08-27 |
| 1295215028 | Amanda Greene | Occupational Therapy Assistant | 3617 Ohare Drive, Mequite, TX 75150 | 2018-08-21 |
| 1053890244 | Barbara Mohrle | Occupational Therapist | 2231 Us Highway 80e, Willow Bend Nursing and Rehab, Mesquite, TX 75150 | 2018-08-09 |
| 1679052120 | Brenda Johnson | Counselor | 4025 Towne Crossing Blvd Apt 1706, Mesquite, TX 75150 | 2018-08-07 |
| Find all providers in zip 75150 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083263875 | Alpha Mental Health Services, LLC | Nurse Practitioner | 2033 Military Pkwy Ste 402d, Mesquite, TX 75149-3670 | 2019-09-05 |
| 1740833359 | Linda G Hampton | Nurse Practitioner | 1905 Pinehurst Ln Apt 6207, Mesquite, TX 75150-7236 | 2019-07-23 |
| 1124689781 | Olivia Obazughanmwen | Nurse Practitioner | 2021 Crawford Dr, Mesquite, TX 75149-7627 | 2019-06-25 |
| 1982267621 | Gloria Nkem Agbadiba | Nurse Practitioner | 1037 Kory Dr, Mesquite, TX 75149-6979 | 2019-04-18 |
| 1023571718 | Secunda Udoye | Nurse Practitioner | 4616 Via Ventura, Mesquite, TX 75150-8229 | 2019-04-09 |
| 1003380437 | Doris K Egyawan | Nurse Practitioner | 624 Yosemite Trl, Mesquite, TX 75149-2583 | 2019-01-18 |
| 1366914541 | Christie Payne | Nurse Practitioner | 3617 Swallow Dr, Mesquite, TX 75181-4321 | 2018-12-27 |
| 1811469471 | Bari Eichelbaum | Nurse Practitioner | 1324 N Galloway Ave Ste 104, Mesquite, TX 75149-2440 | 2018-12-20 |
| 1881183507 | Fatuma Hassen | Nurse Practitioner | 1409 Jessica Ln, Mesquite, TX 75149-6983 | 2018-05-08 |
| 1174023469 | Ahuruchi Joyce Chibueze | Nurse Practitioner | 2820 Turtle Dove Ln, Mesquite, TX 75181-4915 | 2018-02-13 |
| Find all providers in MESQUITE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.