MEDICARE: FARA LYNN CRAWFORD PA-C

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	363A00000X	Physician Assistant	PA04837	TX
2	363AS0400X	Surgical Physician Assistant	PA04837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PA04837	OTHER	TX	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902814544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARA LYNN CRAWFORD PA-C

Provider Business Mailing Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

Provider Business Practice Location Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	04/26/2012

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Directions to “ FARA LYNN CRAWFORD PA-C” Practice Location

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