Provider Demographics
NPI:1285860726
Name:CREW, KELLY T (BS)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:T
Last Name:CREW
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-2702
Mailing Address - Country:US
Mailing Address - Phone:731-780-9810
Mailing Address - Fax:
Practice Address - Street 1:103 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-2702
Practice Address - Country:US
Practice Address - Phone:731-780-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker