Kelli Crisp, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

728510 Issued in TX

Practice address

804 W Montgomery St
Willis, TX 77378-8830

Phone

(936) 890-8000

Fax

(936) 890-9000

NPI assigned

Jun 11, 2019

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

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

• Family Care Plus Clinic LLC

  dba Family Care Plus Clinic

  • Family Medicine Physician
  • Munroe Falls, OH
  • NPI 1669086260
  NPD (past)

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1023677382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 I 45 N STE 220",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773045076",
            "telephone_number": "936-441-1122",
            "fax_number": "936-494-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 W MONTGOMERY ST",
            "city": "WILLIS",
            "state": "TX",
            "postal_code": "773788830",
            "telephone_number": "936-890-8000",
            "fax_number": "936-890-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4015 I 45 N Ste 220",
            "address_purpose": "LOCATION",
            "city": "Conroe",
            "state": "TX",
            "postal_code": "773045076",
            "country_code": "US",
            "telephone_number": "936-441-1122",
            "fax_number": "936-494-4440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISP",
        "first_name": "KELLI",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "TX",
            "license": "728510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcrisp@cwfamilymed.com",
            "affiliation": "Y",
            "affiliationName": "Conroe Willis Family Medicine, PLLC",
            "address_1": "4015 I 45 N Ste 220",
            "city": "Conroe",
            "state": "TX",
            "country_code": "US",
            "postal_code": "773045076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Community Guided Living 'CGL'
• Conroe Willis Family Medicine PLLC
• Cosmos Hospice of Piney Woods, LLC (Virginia's Hospice)
• Karina Crane
• David Joseph Cruz Crawford, LPN
• Judy S Cuello, FNP
• Talin Cusato, FNP-C
• Todd Robert Custer, D.C.
• CVS Pharmacy Inc
• Jason Solita De Guzman, NP

• General Practice Registered Nurse in Willis, TX
• Providers in Willis, TX by specialty
• General Practice Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.