Provider Demographics
NPI:1033800842
Name:CRANDELL, KIM ORVEL (CPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ORVEL
Last Name:CRANDELL
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 JACKSON WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5607
Mailing Address - Country:US
Mailing Address - Phone:702-493-9204
Mailing Address - Fax:
Practice Address - Street 1:623 JACKSON WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5607
Practice Address - Country:US
Practice Address - Phone:702-493-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program