Provider Demographics
NPI:1134127418
Name:CRAWFORD, JILL ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELLEN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BEVINS LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6178
Mailing Address - Country:US
Mailing Address - Phone:859-323-9333
Mailing Address - Fax:502-570-5322
Practice Address - Street 1:202 BEVINS LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6178
Practice Address - Country:US
Practice Address - Phone:859-323-9333
Practice Address - Fax:502-570-5322
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002099363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78020997Medicaid
000000069024OtherANTHEM
1527203Medicare PIN
S30212Medicare UPIN
500021612Medicare PIN