Healthcare Provider Details

I. General information

NPI: 1992617443
Provider Name (Legal Business Name): NATACIA CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 W SPRUCE LEAF DR
SOUTH JORDAN UT
84009-7145
US

IV. Provider business mailing address

4251 W SPRUCE LEAF DR
SOUTH JORDAN UT
84009-7145
US

V. Phone/Fax

Practice location:
  • Phone: 801-419-8368
  • Fax:
Mailing address:
  • Phone: 801-419-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14309440-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: