Provider Demographics
NPI:1073284642
Name:CRAWFORD, KOLEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KOLEAN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 COUNTY ROAD 2003
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-5905
Mailing Address - Country:US
Mailing Address - Phone:254-396-5122
Mailing Address - Fax:
Practice Address - Street 1:1308 PALUXY RD STE 303
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5609
Practice Address - Country:US
Practice Address - Phone:817-579-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner