Healthcare Provider Details

I. General information

NPI: 1043621089
Provider Name (Legal Business Name): HAILEY CRAWFORD ESPARZA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY ELIZABETH CRAWFORD RD

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 3
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

6550 COLUMBUS CIR
LUMBERTON TX
77657-1301
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-8100
  • Fax: 337-475-8510
Mailing address:
  • Phone: 337-263-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1103539
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2444
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNDP-2023-0093
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT83678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: