Healthcare Provider Details

I. General information

NPI: 1780099853
Provider Name (Legal Business Name): CROWLEY PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE A
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

1325 WRIGHT AVE STE A
CROWLEY LA
70526-2226
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-3032
  • Fax: 337-783-7009
Mailing address:
  • Phone: 337-788-3032
  • Fax: 337-783-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200609
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NANCY BRILEY WALKER
Title or Position: MEMBER
Credential: M.D.
Phone: 337-788-3032