Healthcare Provider Details

I. General information

NPI: 1114331949
Provider Name (Legal Business Name): NICHOLAS CROWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 N TULLIS AVE
KANSAS CITY MO
64158
US

IV. Provider business mailing address

11550 GRANADA ST
LEAWOOD KS
66211-1453
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-7546
  • Fax: 214-736-0512
Mailing address:
  • Phone: 913-451-7546
  • Fax: 214-736-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2014016471
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: