MEDICARE: DR. KATHRYN JEAN CROOKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4673	NV

General Provider Information

NPI Number	:	1497774442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN JEAN CROOKS MD

Provider Business Mailing Address
First Line	:	4320 W ARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-5108
Country	:	US
Telephone Number	:	702-389-1306
Fax Number	:	702-914-7312

Provider Business Practice Location Address
First Line	:	4320 W ARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-5108
Country	:	US
Telephone Number	:	702-389-1306
Fax Number	:	702-914-7312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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