Crystal Clark

Primary specialty

DriverTaxonomy code 172A00000X

License

A69874069 Issued in VA

Practice address

3700 S Main St
Blacksburg, VA 24060-7017

Phone

(540) 951-1111

NPI assigned

Dec 29, 2021

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1477213619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 ESSEX CT # 1",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606464",
            "telephone_number": "804-429-7185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-951-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CRYSTAL",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-29",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "VA",
            "license": "A69874069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Crystalclark701@gmail.com",
            "affiliation": "N",
            "address_1": "506 Essex Ct # 1",
            "city": "Blacksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240606464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Emails",
            "affiliation": "N",
            "address_1": "3700 S Main St",
            "city": "Blacksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240607017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taewhi Choi, DO
• Barbara Chrisley, LPC
• Christine Duma Counseling Services LLC
• Matthew Chung, D.O.
• Marie A. Church, MASTER'S DEGREE
• Laura Kathleen Clark
• Sarah J Clark, LCSW
• Michael Howard Clary, DO
• Kelsey Johnson Clear, OTR/L
• Nicole Danielle Clements, M.S. CCC-SLP

• Driver in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Driver in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.