Provider Demographics
NPI:1942183579
Name:DAVIS, CRYSTAL M (NP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12932 S ZUNI DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3472
Mailing Address - Country:US
Mailing Address - Phone:361-652-6774
Mailing Address - Fax:
Practice Address - Street 1:12932 S ZUNI DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-3472
Practice Address - Country:US
Practice Address - Phone:361-652-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6215191-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily