Healthcare Provider Details

I. General information

NPI: 1417153727
Provider Name (Legal Business Name): ELIZABETH SUZANNE CRANK MSN, APRN, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ROY CAMPBELL DR
HAZARD KY
41701-9486
US

IV. Provider business mailing address

PO BOX 1297
HAZARD KY
41702-1297
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-0776
  • Fax: 606-487-0777
Mailing address:
  • Phone: 606-487-0776
  • Fax: 606-487-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberKY-05-1849
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008084
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: