Healthcare Provider Details

I. General information

NPI: 1114904836
Provider Name (Legal Business Name): COURTNEY QUISENBERRY CREWS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG B, STE 101
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE BLDG B, STE 101
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3232
  • Fax: 270-852-1600
Mailing address:
  • Phone: 270-683-3232
  • Fax: 270-852-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37894
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: