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General NPI Number Information
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NPI Number | 1902246705
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Entity Type | Individual
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Provider Name | JENNIFER V CROUCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1106 HAZEL LN
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City | FARMINGTON
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State | MO
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Zip | 63640-1999
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Country | US
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Telephone | 573-756-6751
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Fax | 573-760-8044
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Provider Business Mailing Address
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Address Line | PO BOX 957683
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City | SAINT LOUIS
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State | MO
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Zip | 63195-1921
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Country | US
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Telephone | 573-756-6751
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Fax | 573-760-8044
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2016022193
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License Number State | MO
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