Provider Demographics
NPI:1043785470
Name:CRAWFORD, KATELYNN R
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:R
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:R
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-307-4893
Mailing Address - Fax:816-232-2991
Practice Address - Street 1:2303 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4954
Practice Address - Country:US
Practice Address - Phone:816-232-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018037180363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018037180OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS BOARD CERTIFICATION