Healthcare Provider Details

I. General information

NPI: 1801899612
Provider Name (Legal Business Name): MELISSA A CRAWFORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A MINCKS PA

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 S 9TH ST
SALINA KS
67401
US

IV. Provider business mailing address

2265 S 9TH ST
SALINA KS
67401
US

V. Phone/Fax

Practice location:
  • Phone: 785-823-8381
  • Fax: 785-823-0383
Mailing address:
  • Phone: 785-823-8381
  • Fax: 785-823-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00987
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: