Healthcare Provider Details

I. General information

NPI: 1386490605
Provider Name (Legal Business Name): KAMARA JENAE TIERNEY CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N TEXAS AVE STE 3100
WEBSTER TX
77598-4970
US

IV. Provider business mailing address

17117 NULAKE WEST CT
HOUSTON TX
77044-1479
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-7135
  • Fax:
Mailing address:
  • Phone: 916-549-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: