Individual provider Active NPI

Crystal Marie Stanberry, NP

  • Nurse Practitioner
  • Texarkana, AR
National Provider Identifier
1053840082
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A005171 Issued in AR
Practice address
1205 E 35TH St
Texarkana, AR 71854-2746
Phone
(903) 735-5355
NPI assigned
Jun 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AP134293 TX
Adult Health Nurse Practitioner 363LA2200X A005171 AR
Gerontology Nurse Practitioner 363LG0600X A005171 AR
Gerontology Nurse Practitioner 363LG0600X AP134293 TX
Primary Care Nurse Practitioner 363LP2300X A005171 AR
Primary Care Nurse Practitioner 363LP2300X AP134293 TX
Nurse Practitioner 363L00000X A005171 AR Primary

Addresses

Primary practice location

1205 E 35TH St
Texarkana, AR 71854-2746

Mailing address

11267 Highway 82
Texarkana, AR 71854-0844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170721002833 AR Practitioner - Nurse Practitioner 0840560926 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Medical Plus Nurse Practitioner CurrentSince Nov 1, 2022 Accepting new patients
Wimberley Wellness PLLC Past Accepting new patients

Locations

609 SW 8th St
Ste 600
Bentonville, AR 72712
Phone (479) 286-1133

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1496534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1053840082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11267 HIGHWAY 82",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718540844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 E 35TH ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718542746",
            "telephone_number": "903-735-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANBERRY",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-04",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP134293",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AR",
            "license": "A005171",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AR",
            "license": "A005171",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP134293",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AR",
            "license": "A005171",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP134293",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A005171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, AR

Sources for this page

Verify at the official NPI Registry.