Healthcare Provider Details

I. General information

NPI: 1659383545
Provider Name (Legal Business Name): REBECCA LEE CROUCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/20/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 BEECH SPRINGS RD
JONESBORO LA
71251-2014
US

IV. Provider business mailing address

166 BEECH SPRINGS RD
JONESBORO LA
71251-2014
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-3668
  • Fax: 318-259-3950
Mailing address:
  • Phone: 318-259-3668
  • Fax: 318-259-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013773
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: