Crystal Teresa Wall, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5010941 Issued in NC

Practice address

515 Sawyers Mill Rd Apt 105
Charlotte, NC 28262-1893

Phone

(704) 724-7697

NPI assigned

Aug 27, 2018

Last updated

Nov 26, 2019By 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

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  NC

  Medicare reassignment NPD
• Personal Elite Homecare LLC

  • In Home Supportive Care Agency
  • Charlotte, NC
  • NPI 1417592643
  NPD Authorized official

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1093296022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 SAWYERS MILL RD APT 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 SAWYERS MILL RD APT 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282621893",
            "telephone_number": "704-724-7697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "CRYSTAL",
        "middle_name": "TERESA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5010941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Alfred Walker, M.D.
• Yvette Walker, N.P.
• Walkers Specialty Pharmacy LLC (Walkers Drug Store)
• Carla Favaro Walkley, NP
• Ruth Crosby Walkup, PMHNP-BC, FNP-BC
• Fallon Victoria Wall
• Felisha M Wall, RN
• George Bryan Wall, DMD
• Kelli Anne Wall
• Kelli Maureen Wall, FNP-C

• Family Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.