Provider Demographics
NPI:1033345053
Name:CROWL, KIMBERLY ANN (RD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:CROWL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:CROWL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:350 E BAYFRONT PKWY
Mailing Address - Street 2:UNIT C
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-2410
Mailing Address - Country:US
Mailing Address - Phone:814-455-2279
Mailing Address - Fax:814-871-1786
Practice Address - Street 1:350 E BAYFRONT PKWY
Practice Address - Street 2:UNIT C
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-2410
Practice Address - Country:US
Practice Address - Phone:814-455-2279
Practice Address - Fax:814-871-1786
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered