Healthcare Provider Details

I. General information

NPI: 1295172872
Provider Name (Legal Business Name): JAMES PARKER CREWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N DIXIE HWY
CAVE CITY KY
42127-9526
US

IV. Provider business mailing address

207 N DIXIE HWY
CAVE CITY KY
42127-9526
US

V. Phone/Fax

Practice location:
  • Phone: 270-773-3736
  • Fax: 270-773-2363
Mailing address:
  • Phone: 270-773-3736
  • Fax: 270-773-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES CREWS
Title or Position: OWNER
Credential: MD
Phone: 270-773-3736