Healthcare Provider Details

I. General information

NPI: 1588938450
Provider Name (Legal Business Name): KELLY SMITH CRAWFORD DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 ARDENNES CT
SHREVEPORT LA
71115-4613
US

IV. Provider business mailing address

2539 VIKING DRIVE SUITE 101
BOSSIER CITY LA
71111-2165
US

V. Phone/Fax

Practice location:
  • Phone: 318-347-6220
  • Fax:
Mailing address:
  • Phone: 318-747-8100
  • Fax: 318-932-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06750
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: