Healthcare Provider Details

I. General information

NPI: 1285438713
Provider Name (Legal Business Name): ANNA REBECCA CRAWLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 06/19/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 PARK SOUTH DR STE 575
CHARLOTTE NC
28210-3272
US

IV. Provider business mailing address

2524 BURKE SMOKEY CREEK RD
LENOIR NC
28645-7302
US

V. Phone/Fax

Practice location:
  • Phone: 919-618-3048
  • Fax:
Mailing address:
  • Phone: 828-443-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number313279
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022435
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: