Provider Demographics
NPI:1447442678
Name:FLEENER, CRYSTAL LEANN (APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEANN
Last Name:FLEENER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:EMORY
Other - Last Name:GRESHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN
Mailing Address - Street 1:600 BLUES LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8022
Mailing Address - Country:US
Mailing Address - Phone:573-364-8822
Mailing Address - Fax:573-341-5969
Practice Address - Street 1:600 BLUES LAKE PKWY
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8022
Practice Address - Country:US
Practice Address - Phone:573-364-8822
Practice Address - Fax:573-341-5969
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner