Crystal Elaine Clough, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN269181 Issued in GA

Practice address

39 Freedom Dr NE
Cartersville, GA 30121-8095

Phone

(706) 844-7132

NPI assigned

Sep 12, 2022

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 GA

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 and National Provider Directory roles.

• 24 On Physicians, PC

  • Hospitalist Physician
  • Rome, GA
  • NPI 1912956251
  Medicare reassignment NPD
• Eleve Luxe Aesthetics & Medspa

  • Family Nurse Practitioner
  • Cartersville, GA
  • NPI 1881524387
  NPD Authorized official
• 24 On Physicians, P.C.

  • Hospitalist Physician
  • Attleboro, MA
  • NPI 1790104511
  NPD

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1659092385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 FREEDOM DR NE",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301218095",
            "telephone_number": "706-844-7132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 FREEDOM DR NE",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301218095",
            "telephone_number": "706-844-7132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUGH",
        "first_name": "CRYSTAL",
        "middle_name": "ELAINE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN269181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashunte Denise Claybrooks, LPC
• Kathryn Head Claytor, FNP-C
• Paul Clements, PH.D.
• Tinsley Choate Cline, DMD
• William James Cline, DMD
• Jessica R Coburn, FNP-C
• Jeannette Chua Cocabo, MD
• Renee' S. Cochran, NP
• Sara Beth Coker, NP-C
• Mitzi Collins

• Family Nurse Practitioner in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.