MEDICARE: CRAZYCRE8

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1891458212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAZYCRE8

Provider Business Mailing Address
First Line	:	2420 CHIMNEY POINT LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4364
Country	:	US
Telephone Number	:	859-608-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 CHIMNEY POINT LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4364
Country	:	US
Telephone Number	:	859-608-9805
Fax Number	:

Authorized Official
Title or Position	:	APRN/CO-OWNER
Name	:	MS. LEIGHNIA T NANCE
Credential	:	APRN
Telephone Number	:	859-608-9805

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/21/2021

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Directions to “CRAZYCRE8 ” Practice Location

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