Provider Demographics
NPI:1043770027
Name:CRAWFORD, PAIGE A (RDN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:A
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:301 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3487
Practice Address - Country:US
Practice Address - Phone:270-651-9696
Practice Address - Fax:270-651-0385
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY246328OtherKY LICENSURE
14427260OtherCAQH