Individual provider Active NPI

Crystal Dawn Lowder-Tibbs, FNP

  • Family Nurse Practitioner
  • Boones Mill, VA
National Provider Identifier
1811509599
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024179874 Issued in VA
Practice address
1054 Boones Mill Rd
Boones Mill, VA 24065-4318
Phone
(276) 724-0967
NPI assigned
Aug 23, 2020
Last updated
Aug 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024179874 VA Primary
Family Medicine Physician 207Q00000X 0024179874 VA

Addresses

Primary practice location

1054 Boones Mill Rd
Boones Mill, VA 24065-4318

Mailing address

1054 Boones Mill Rd
Boones Mill, VA 24065-4318
Phone (276) 724-0967

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20210609000164 VA Practitioner - Nurse Practitioner 9335549690 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

245 Holston Rd
Suite B
Wytheville, VA 24382-4486
Phone (276) 227-0460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brock Hughes Free Clinic, Inc. CurrentSince Apr 1, 2021 Accepting new patients
Wythe County Physician Practices LLC Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Wythe County Physician Practices LLC Past Accepting new patients
Wythe County Physician Practices LLC Past Accepting new patients

Locations

791 Fort Chiswell Rd
Ste A
Max Meadows, VA 24360
Phone (267) 637-6641

306 S Main St
Rural Retreat, VA 24368
Phone (276) 686-4007

1155 N 4th St
Ste 502
Wytheville, VA 24382
Phone (276) 227-0375

245 Holston Rd
Ste B
Wytheville, VA 24382
Phone (276) 227-0460

360 Virginia Ave
Wytheville, VA 24382
Phone (276) 228-0080

360 Virginia Ave
#B
Wytheville, VA 24382
Phone (276) 223-1430

450 W Monroe St
Wytheville, VA 24382
Phone (276) 223-0558

600 W Ridge Rd
Wytheville, VA 24382
Phone (276) 228-0200

Interoperability endpoints

  • Direct secure messaging: crystal.lowder-tibbs.1@19847.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1598140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1811509599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 BOONES MILL RD",
            "city": "BOONES MILL",
            "state": "VA",
            "postal_code": "240654318",
            "telephone_number": "276-724-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 BOONES MILL RD",
            "city": "BOONES MILL",
            "state": "VA",
            "postal_code": "240654318",
            "telephone_number": "276-724-0967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOWDER-TIBBS",
        "first_name": "CRYSTAL",
        "middle_name": "DAWN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-23",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024179874",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0024179874",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boones Mill, VA

Sources for this page

Verify at the official NPI Registry.