Healthcare Provider Details

I. General information

NPI: 1730261330
Provider Name (Legal Business Name): KEVIN W CRAWFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SEWELL DR
SPARTA TN
38583-1223
US

IV. Provider business mailing address

PO BOX 440167
NASHVILLE TN
37244-0167
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-9211
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-620-2320
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN10563
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN51999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: