Healthcare Provider Details

I. General information

NPI: 1497694954
Provider Name (Legal Business Name): MADISON RAY CRUMPLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CROATAN HWY
KILL DEVIL HILLS NC
27948-8895
US

IV. Provider business mailing address

140 SWEETEN CREEK RD
ASHEVILLE NC
28803-1526
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-7870
  • Fax: 252-565-0534
Mailing address:
  • Phone: 828-398-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001016537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: