Provider Demographics
NPI:1285206680
Name:CRANDALL, JAMES STEVEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PERSON STREET
Mailing Address - Street 2:
Mailing Address - City:STOCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78160
Mailing Address - Country:US
Mailing Address - Phone:830-996-3701
Mailing Address - Fax:
Practice Address - Street 1:601 PERSON STREET
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:TX
Practice Address - Zip Code:78160
Practice Address - Country:US
Practice Address - Phone:830-996-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily