Healthcare Provider Details

I. General information

NPI: 1255896320
Provider Name (Legal Business Name): CHESTER PAUL CRAWFORD JR. LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6263 HIGHWAY 49 S
PARAGOULD AR
72450-6093
US

IV. Provider business mailing address

6263 HIGHWAY 49 S
PARAGOULD AR
72450-6093
US

V. Phone/Fax

Practice location:
  • Phone: 870-240-0444
  • Fax: 870-240-0466
Mailing address:
  • Phone: 870-240-0444
  • Fax: 870-240-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL51294
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: