Healthcare Provider Details

I. General information

NPI: 1184046336
Provider Name (Legal Business Name): MICHELE DIANE CRAWLEY APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE DIANE PEARCE

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
HENRYETTA OK
74437-3893
US

IV. Provider business mailing address

2401 W MAIN ST
HENRYETTA OK
74437-3893
US

V. Phone/Fax

Practice location:
  • Phone: 918-652-9650
  • Fax: 918-652-7827
Mailing address:
  • Phone: 918-652-9650
  • Fax: 918-652-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84737
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number84737
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: