Crystal Kay Lieblang, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704239482 Issued in MI

Practice address

1222 10TH Ave
Port Huron, MI 48060-3406

Phone

(810) 985-9681

Fax

(810) 985-5310

NPI assigned

Mar 25, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Crystal Kay Pennell Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cardiology Assoc of Port HuronGroup PAC ID 1658348776, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Port Huron Hospital, Port Huron, MI, CCN 230216
• Lake Huron Medical Center Hospital, Port Huron, MI, CCN 230031
• McKenzie Health System Hospital, Sandusky, MI, CCN 231314
• Deckerville Community Hospital Hospital, Deckerville, MI, CCN 231311

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystal.pennell.p1@direct.porthuronheartcenter.nextgenshare.com
• Direct secure messaging: cpennell794472@direct.hfhs.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Cardiology Assoc of Port Huron

  • Cardiovascular Disease Physician
  • Port Huron, MI
  • NPI 1033198593
  Medicare reassignment Care Compare group NPD

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

• Deckerville Community Hospital Inc

  • Critical Access Hospital
  • Deckerville, MI
  • NPI 1619095718
  Care Compare affiliation
• Deckerville Community Hospital, Inc

  dba Port Sanilac Healthcare

  • Clinic/Center
  • Port Sanilac, MI
  • NPI 1013799469

  Hospital

  Care Compare affiliation
• Deckerville Community Hospital, Inc.

  • Family Medicine Physician
  • Deckerville, MI
  • NPI 1164818977

  Hospital

  Care Compare affiliation
• McKenzie Memorial Hospital

  dba McKenzie Health System

  • Critical Access Hospital
  • Sandusky, MI
  • NPI 1497750608
  Care Compare affiliation
• McKenzie Memorial Hospital

  dba McKenzie Professional Practice

  • Family Medicine Physician
  • Sandusky, MI
  • NPI 1831443761

  Hospital

  Care Compare affiliation
• McLaren Port Huron

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1982685384
  Care Compare affiliation
• Prime Healthcare Services-Port Huron LLC

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1306227764
  Care Compare affiliation

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1154783470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603406",
            "telephone_number": "810-985-9681",
            "fax_number": "810-985-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603406",
            "telephone_number": "810-985-9681",
            "fax_number": "810-985-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBLANG",
        "first_name": "CRYSTAL",
        "middle_name": "KAY",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704239482",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704239482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "PENNELL",
            "middle_name": "KAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jerry Douglas Lickfelt, CPSS
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• Adult Health Nurse Practitioner in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Adult Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.