Provider Demographics
NPI:1073168837
Name:CRAWFORD, KAYLA KRYSTYNA (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:KRYSTYNA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLEARWATER RD
Mailing Address - Street 2:
Mailing Address - City:JUDSONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72081-9761
Mailing Address - Country:US
Mailing Address - Phone:501-454-3524
Mailing Address - Fax:
Practice Address - Street 1:60 GREERS FERRY RD
Practice Address - Street 2:
Practice Address - City:DRASCO
Practice Address - State:AR
Practice Address - Zip Code:72530-9130
Practice Address - Country:US
Practice Address - Phone:870-668-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily