MEDICARE: TANNA LENAE CRAWFORD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2019012695	MO

General Provider Information

NPI Number	:	1144600768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANNA LENAE CRAWFORD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 802843
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-2843
Country	:	US
Telephone Number	:	417-730-6430
Fax Number	:	417-269-7567

Provider Business Practice Location Address
First Line	:	1423 N JEFFERSON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-1917
Country	:	US
Telephone Number	:	417-269-6891
Fax Number	:	417-269-5595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/01/2026

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