Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1306096276 Deactivated / Inactive NPI Female Practitioner

Crystal N Etheridge , LPN

Licensed Practical Nurse • Bellport, NY

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Crystal Etheridge has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 26, 2008
NPI Deactivation Date March 13, 2019
Total Practice Duration ~11 Years of Practice (2008 – 2019)

Professional Overview & Biography Verified Profile Summary

Crystal Etheridge, LPN was a registered Licensed Practical Nurse practicing in Bellport, NY. Throughout an active medical career spanning 11 years, Crystal Etheridge provided care at the practice location at 319 STATION RD until profile deactivation on 2019-03-13.

Practice Location & Contact Primary Location

Practice Address

319 Station Rd

Bellport, NY 117132116

Telephone 7048984282

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Bellport, NY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 8.0 Yrs
Regional Practice Density
41 Specialists

Practicing in Bellport, NY (23738 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License NY 292143

An individual 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.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 13, 2019

Record deactivated on March 13, 2019

NPI Profile Active September 26, 2008

NPI status registered as active in NPPES database

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Updated Practice Location September 26, 2008

Registered at 319 STATION RD, BELLPORT, NY 117132116 (Tel: 7048984282)

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Updated Business Mailing Address September 26, 2008

Registered at 319 STATION RD, BELLPORT, NY 117132116 (Tel: 7048984282)

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Provider Name / Credentials Updated September 26, 2008

Recorded as CRYSTAL ETHERIDGE, LPN

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 26, 2008

Licensed Practical Nurse (License #292143 in NY)

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Initial NPI Registration & Enumeration September 26, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1306096276
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 26, 2008
Last Update: September 26, 2008
Deactivation Date: March 13, 2019

Mailing Address

319 Station Rd

Bellport, NY 117132116

Phone: 7048984282

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.