Healthcare Provider Details

I. General information

NPI: 1417869355
Provider Name (Legal Business Name): KELSEY CREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KINGSWOOD CIR
BLOOMINGDALE GA
31302-8152
US

IV. Provider business mailing address

175 KINGSWOOD CIR
BLOOMINGDALE GA
31302-8152
US

V. Phone/Fax

Practice location:
  • Phone: 915-227-7235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1000042
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: