Active NPI
Kelley Champ Crumpler, LVN
- Licensed Vocational Nurse
- College Station, TX
National Provider Identifier
1629544630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 195614
- Practice address
- 4508 Mills Park Cir Ste 100
College Station, TX 77845-1100 - Phone
- (979) 402-3714
- NPI assigned
- Oct 17, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 195614 | TX | Primary |
Addresses
Primary practice location
4508 Mills Park Cir Ste 100
College Station, TX 77845-1100
Mailing address
4508 Mills Park Cir Ste 100
College Station, TX 77845-1100
Phone (979) 402-3714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 195614 | TX | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539734400000",
"number": "1629544630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4508 MILLS PARK CIR STE 100",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778451100",
"telephone_number": "979-402-3714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4508 MILLS PARK CIR STE 100",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778451100",
"telephone_number": "979-402-3714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUMPLER",
"first_name": "KELLEY",
"middle_name": "CHAMP",
"credential": "LVN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-17",
"last_updated": "2018-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "TX",
"license": "195614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.