Healthcare Provider Details

I. General information

NPI: 1346724911
Provider Name (Legal Business Name): KATRINA CROWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 08/11/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP
LACKLAND AFB TX
78236-5638
US

IV. Provider business mailing address

750 SCOTT CIRCLE
JBPH-HICKAM AFB HI
96853-5399
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-2003
  • Fax:
Mailing address:
  • Phone: 808-448-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: