Healthcare Provider Details

I. General information

NPI: 1437365095
Provider Name (Legal Business Name): JEFFREY A CRAWFORD C.R.N.P,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25442 AL HIGHWAY 127
ELKMONT AL
35620-6608
US

IV. Provider business mailing address

25442 AL HIGHWAY 127 PO BOX 449
ELKMONT AL
35620-6608
US

V. Phone/Fax

Practice location:
  • Phone: 256-732-3712
  • Fax: 256-732-3714
Mailing address:
  • Phone: 256-732-3712
  • Fax: 256-732-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0368408-28
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: