Provider Demographics
NPI:1376042069
Name:CRAWFORD, ANDREA LOUISE (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LOUISE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7846
Mailing Address - Country:US
Mailing Address - Phone:573-631-3552
Mailing Address - Fax:
Practice Address - Street 1:205 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2509
Practice Address - Country:US
Practice Address - Phone:573-631-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health