Individual ProviderCrystal NealNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7900 W Jefferson Blvd Ste 201, Fort Wayne, IN 46804-4128(260) 969-7191(260) 479-3514PECOS EnrollmentBased on the most recent information from CMS, provider Crystal Neal is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1730787599Provider TypeIndividualFull NameNeal, CrystalTitleMs.CredentialNPGenderFemaleSole ProprietorNoEnumeration Date10/14/2020Last Updated1/29/2026Contact InformationPractice LocationPractice Address7900 W Jefferson Blvd Ste 201, Fort Wayne, IN 46804-4128Phone(260) 969-7191Fax(260) 969-7253Mailing LocationMailing Address6920 Pointe Inverness Way, Fort Wayne, IN 46804-7938Phone(260) 479-3514Fax(260) 479-3520Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71011624AIndianaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28222257AIndianaProvider IdentifiersIDDescriptionIssuerID300055448DescriptionMedicaidIssuerUnlistedIndiana