Healthcare Provider Details

I. General information

NPI: 1508947938
Provider Name (Legal Business Name): REBECCA D CRAWFORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 W TRUMAN RD
INDEPENDENCE MO
64050-3436
US

IV. Provider business mailing address

PO BOX 838
SHAWNEE MISSION KS
66201-0838
US

V. Phone/Fax

Practice location:
  • Phone: 816-736-6901
  • Fax: 816-836-4460
Mailing address:
  • Phone: 913-469-4244
  • Fax: 913-469-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2004007952
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: