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General NPI Number Information
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NPI Number | 1780961862
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Entity Type | Individual
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Provider Name | KEVIN ELLIOTT CRAWFORD PA, NP
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Gender | Male
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 512 E SOUTHERN AVE SUITE D
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City | TEMPE
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State | AZ
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Zip | 85282-5209
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Country | US
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Telephone | 480-921-0767
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Fax | 480-921-9567
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Provider Business Mailing Address
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Address Line | 512 E SOUTHERN AVE SUITE D
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City | TEMPE
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State | AZ
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Zip | 85282-5209
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Country | US
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Telephone | 480-921-0767
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Fax | 480-921-9567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN047180
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License Number State | AZ
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