Provider Demographics
NPI:1114904836
Name:CREWS, COURTNEY QUISENBERRY (MD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:QUISENBERRY
Last Name:CREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLDG B, STE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG B, STE 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50002485OtherPASSPORT
KY65069321Medicaid
KY000000300269OtherBLUE CROSS
KY50002485OtherPASSPORT
KY000000300269OtherBLUE CROSS