MEDICARE: KATHERINE CROW NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	2021103258	SC

General Provider Information

NPI Number	:	1518688621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE CROW NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2 INNOVATION DR STE 350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5269
Country	:	US
Telephone Number	:	864-516-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 INNOVATION DR STE 350
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5269
Country	:	US
Telephone Number	:	864-516-1170
Fax Number	:

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

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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Directions to “ KATHERINE CROW NURSE PRACTITIONER” Practice Location

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