Provider Demographics
NPI:1376304964
Name:CRUM, KEAIRRA
Entity Type:Individual
Prefix:
First Name:KEAIRRA
Middle Name:
Last Name:CRUM
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 1:5734 N ATTLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-6056
Mailing Address - Country:US
Mailing Address - Phone:713-418-9411
Mailing Address - Fax:
Practice Address - Street 1:5734 N ATTLEBURG DR
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-6056
Practice Address - Country:US
Practice Address - Phone:713-418-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care