Crystal Lynn La Rose, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

223670 Issued in AZ

Practice address

PO Box 860
Whiteriver, AZ 85941-0860

Phone

(928) 338-4911

NPI assigned

Apr 2, 2024

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

Other names 1

• Crystal Lynn Clyde Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

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.

• DHHS IHS Phoenix Area

  • General Acute Care Hospital
  • Whiteriver, AZ
  • NPI 1427335140

  TX

  Medicare reassignment NPD
• DHHS,PHS,Naihs, Gallup Indian Medical Center

  • General Acute Care Hospital
  • Gallup, NM
  • NPI 1225002322

  TX

  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  • Clinic/Center
  • Cibecue, AZ
  • NPI 1427335181
  NPD

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1033961180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 TROTWOOD DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864068007",
            "telephone_number": "928-302-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "telephone_number": "928-338-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA ROSE",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "AZ",
            "license": "223670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "CLYDE",
            "middle_name": "LYNN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Archie M Kinney, PA C
• Anna Un-Un Kit, PHARM.D.
• Chelsea J. Kleinmeyer, R.N.
• Mark Wesley Kleve, M.D.
• Heidi A Knepper, LMSW
• Janis Marion Lando, RD,CDE
• Lisa Dang Le, PHARMD
• Levy M Leconte, PTA
• Shauna Lee, PHARMD
• Danica Liu, PHARMD

• Advanced Practice Midwife in Whiteriver, AZ
• Providers in Whiteriver, AZ by specialty
• Advanced Practice Midwife in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.