Provider Demographics
NPI:1194832329
Name:CROW, BILLY DON JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:DON
Last Name:CROW
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DRUMRIGHT
Mailing Address - State:OK
Mailing Address - Zip Code:74030-5660
Mailing Address - Country:US
Mailing Address - Phone:918-549-5596
Mailing Address - Fax:
Practice Address - Street 1:2323 N OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:DRUMRIGHT
Practice Address - State:OK
Practice Address - Zip Code:74030-5660
Practice Address - Country:US
Practice Address - Phone:918-549-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCTP-000114367500000X
OKR0082272367500000X
ARCO280CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522349OtherMEDICARE GROUP PIN
OK200056800AMedicaid
OK900522349OtherMEDICARE GROUP PIN
WI211050102Medicare Oscar/Certification