Crystal Lynn Bloomer, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

87767 Issued in NC

Practice address

572 Executive PL
Fayetteville, NC 28305-5585

Phone

(910) 864-8739

Fax

(910) 864-8222

NPI assigned

Apr 21, 2026

Last updated

Apr 21, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Ats of North Carolina, LLC

  dba Carolina Treatment Center of Fayetteville

  • Methadone Clinic
  • Fayetteville, NC
  • NPI 1376680199
  NPD (past)
• Ats of North Carolina, LLC

  dba Shelby Comprehensive Treatment Center

  • Methadone Clinic
  • Shelby, NC
  • NPI 1609551688
  NPD (past)

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

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1275478943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055585",
            "telephone_number": "910-864-8739",
            "fax_number": "910-864-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055585",
            "telephone_number": "910-864-8739",
            "fax_number": "910-864-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMER",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NC",
            "license": "87767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Block, OTR/L
• Kyle Paul Blomgren, DO
• Blood & Cancer Clinic, P.a.
• Blood and Cancer Clinic, PA
• Bloom in Journey PLLC
• Bridget Blount
• Andrea Blue, RBT
• Carolyn Blue
• Ciji Latrice Blue, LCSWA
• Crystal Nicole Blue, LCSWA

• Licensed Practical Nurse in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Licensed Practical Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; 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.