Healthcare Provider Details

I. General information

NPI: 1750114989
Provider Name (Legal Business Name): KATHY MICHELLE CRAWFORD PMNHP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 N ACADEMY BLVD STE 3200
COLORADO SPRINGS CO
80918-4083
US

IV. Provider business mailing address

5265 N ACADEMY BLVD STE 3200
COLORADO SPRINGS CO
80918-4083
US

V. Phone/Fax

Practice location:
  • Phone: 719-256-0060
  • Fax:
Mailing address:
  • Phone: 719-256-0060
  • Fax: 719-208-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.10000045-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: