NPIMap

Individual provider Active NPI

Crystal Nicole Chancellor, APRN

  • Gerontology Nurse Practitioner
  • Little Rock, AR
National Provider Identifier
1013515857
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
212540 Issued in AR
Practice address
2200 S Bowman Rd
Little Rock, AR 72211-4136
Phone
(870) 828-1022
NPI assigned
Oct 14, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 212540 AR Primary

Addresses

Primary practice location

2200 S Bowman Rd
Little Rock, AR 72211-4136

Mailing address

212 Mountain View Rd
Glenwood, AR 71943-9183
Phone (870) 828-1022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221209002060 AR Practitioner - Nurse Practitioner 1254700446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quality Healthcare Resources LLCGroup PAC ID 0345305876, 29 clinicians

Practice addresses (Care Compare)

2200 S Bowman Rd
Suite a
Little Rock, AR 72211-4136
Phone (501) 558-4111

Hospital & facility affiliations

  • Care IV Home Health Home health agency, Hot Springs, AR, CCN 047174
  • Center Well Home Health Home health agency, Hot Springs, AR, CCN 047105
  • CHI St Vincent Hot Springs Health at Home Home health agency, Hot Springs National, AR, CCN 047006
  • CHI St. Vincent Hospital Hot Springs Hospital, Hot Springs, AR, CCN 040026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
212540ARMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Quality Healthcare Resources LLC CurrentSince Aug 21, 2023 Accepting new patients
Icarepro of Texas, PA Past Accepting new patients
Arkansas Hematology and Oncology PLLC PastSince Oct 1, 2020 Accepting new patients

Locations

2200 S Bowman Rd
Ste A
Little Rock, AR 72211
Phone (501) 558-4100

2200 S Bowman Rd
Little Rock, AR 72211
Phone (501) 558-4100

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1013515857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 MOUNTAIN VIEW RD",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719439183",
            "telephone_number": "870-828-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 S BOWMAN RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114136",
            "telephone_number": "870-828-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCELLOR",
        "first_name": "CRYSTAL",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "212540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.