MEDICARE: KAYLEY CRANDALL

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	246ZA2600X	Medical Art Specialist/Technologist		IN

General Provider Information

NPI Number	:	1770420218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEY CRANDALL

Provider Business Mailing Address
First Line	:	26191 E SHORE DR APT 2
Second Line	:
City	:	EDWARDSBURG
State	:	MI
Zip	:	49112-8488
Country	:	US
Telephone Number	:	574-347-5789
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 GRAPE RD STE 1205A
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1007
Country	:	US
Telephone Number	:	574-347-5789
Fax Number	:

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

Provider Enumeration Date	:	05/01/2026
Last Update Date	:	05/01/2026

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Directions to “ KAYLEY CRANDALL ” Practice Location

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