Provider Demographics
NPI:1134123466
Name:CRAWFORD, RICHARD TODD (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TODD
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:STE 603
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1471
Mailing Address - Country:US
Mailing Address - Phone:859-277-2211
Mailing Address - Fax:859-277-7575
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:STE 603
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-277-3636
Practice Address - Fax:859-277-7575
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA258207Q00000X
KYPA 258363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95001822Medicaid
KY95001822Medicaid
KYR39898Medicare UPIN