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NPI Code Detail

MEDICARE: MRS. LACIE WHITTEN CRAWFORD PA-C

MEDICARE: MRS. LACIE WHITTEN CRAWFORD PA-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
1363AM0700XMedical Physician Assistant889AL
2363AM0700XMedical Physician Assistant2331TN

General Provider Information

NPI Number : 1598007106
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LACIE WHITTEN CRAWFORD PA-C
Provider Business Mailing Address
First Line : 1211 UNION AVE STE 330
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-6655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 57 GERMANTOWN CT STE 100
Second Line :
City : CORDOVA
State : TN
Zip : 38018-4274
Country : US
Telephone Number : 901-435-8550
Fax Number : 901-478-0781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2013
Last Update Date : 04/20/2026

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Directions to “ MRS. LACIE WHITTEN CRAWFORD PA-C” Practice Location

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