Healthcare Provider Details

I. General information

NPI: 1164224606
Provider Name (Legal Business Name): LANDRY CRABTREE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 TROY RD
EDWARDSVILLE IL
62025-2540
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-433-6410
  • Fax:
Mailing address:
  • Phone: 618-433-6410
  • Fax: 618-433-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209032207
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2024047256
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: