MEDICARE: IMANI CROSBY

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	54066	NM
2	363L00000X	Nurse Practitioner	AP138094	TX

General Provider Information

NPI Number	:	1831674555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI CROSBY

Provider Business Mailing Address
First Line	:	7910 BELT LINE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 BELT LINE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8130
Country	:	US
Telephone Number	:	972-980-6753
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/30/2021

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Directions to “ IMANI CROSBY ” Practice Location

Language	Start Address	Practice Location

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