Basic Information
| Provider Information | |||||||||
| NPI: | 1831773548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOKORNEY | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 ROCKY COVE LN | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775393221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209188982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6807 EMMETT F LOWRY EXPY STE 108 | ||||||||
| Address2: | |||||||||
| City: | TEXAS CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775912547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4099455444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2021 | ||||||||
| LastUpdateDate: | 05/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1036649 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.