Provider Demographics
NPI:1295361194
Name:CROWDER, CONNIE KAYE
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:KAYE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3209
Mailing Address - Country:US
Mailing Address - Phone:210-632-7260
Mailing Address - Fax:
Practice Address - Street 1:204 N WILLOW WAY
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3209
Practice Address - Country:US
Practice Address - Phone:210-632-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula