Provider Demographics
NPI:1003221086
Name:CROWDER, MIRANDA KAY (NNP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:KAY
Last Name:CROWDER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MISS
Other - First Name:MIRANDA
Other - Middle Name:KAY
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 LOCKHURST DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5185
Mailing Address - Country:US
Mailing Address - Phone:214-733-7088
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125652363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal