MEDICARE: JOETTA LYNN CRAWFORD RN, BSN, FNP-C

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	163WH0200X	Home Health Registered Nurse	RN330418	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39-4451428	OTHER	GA	IRS

General Provider Information

NPI Number	:	1275409195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOETTA LYNN CRAWFORD RN, BSN, FNP-C

Provider Business Mailing Address
First Line	:	1133 BOWLIN DR
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-7079
Country	:	US
Telephone Number	:	615-397-1896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 BOWLIN DR
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-7079
Country	:	US
Telephone Number	:	615-397-1896
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	03/10/2026

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