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CRYSTAL CLARK
NPI 1194391185
Licensed Practical Nurse in Winston Salem, NC

Active since June 01, 2021
650 HIGHLAND AVE # 100, WINSTON SALEM, NC 27101(336) 607-8523 Get Directions Write a Review

NPPES record last updated: June 1, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Crystal Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CRYSTAL CLARK (NPI 1194391185) is an individual licensed practical nurse in Winston Salem, North Carolina, licensed in North Carolina (091485) and active in the NPI registry since June 2021.

NPPES Registry Identity

NPI1194391185
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameCRYSTAL CLARK
Location Address650 HIGHLAND AVE # 100Winston Salem, NC 27101-4304
Mailing Address284 Executive Park Dr Ste 100Concord, NC 28025-1833
Phone(336) 607-8523
Sole ProprietorNo
Enumeration DateJune 1, 2021
NPPES CertifiedMay 31, 2021
✔ NPI 1194391185 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NC · 091485
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
650 HIGHLAND AVE # 100, Winston Salem, NC 27101
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Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. MARY ELIZABETH GREEN LPN
Licensed Practical Nurse
650 HIGHLAND AVE # 100
WINSTON SALEM, NC 27101
Forsyth County (336) 607-8523
LAVORICE SMITH
Social Worker (Clinical)
650 HIGHLAND AVE # 100
WINSTON SALEM, NC 27101
Forsyth County (336) 607-8523

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crystal Clark's NPI number?

The NPI number for Crystal Clark is 1194391185. It was assigned to this individual provider in the NPPES registry on June 1, 2021.

Where is Crystal Clark located?

Crystal Clark practices at 650 Highland Ave # 100, Winston Salem, NC 27101. The listed phone number is (336) 607-8523.

What is Crystal Clark's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Crystal Clark was last updated on June 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.