Provider Demographics
NPI:1871788190
Name:MCPHERSON, CRYSTALRAE CODDINGTON (CSFA)
Entity type:Individual
Prefix:
First Name:CRYSTALRAE
Middle Name:CODDINGTON
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RAE
Other - Last Name:CODDINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:PO BOX 2405
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7405
Mailing Address - Country:US
Mailing Address - Phone:602-708-2493
Mailing Address - Fax:
Practice Address - Street 1:212 JOYCE ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-9524
Practice Address - Country:US
Practice Address - Phone:602-708-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant