Provider Demographics
NPI:1376601054
Name:CARMACK-CRAWFORD, JANET LORENE
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LORENE
Last Name:CARMACK-CRAWFORD
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 1:1204 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4143
Mailing Address - Country:US
Mailing Address - Phone:870-239-5437
Mailing Address - Fax:870-239-4211
Practice Address - Street 1:1204 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4143
Practice Address - Country:US
Practice Address - Phone:870-239-5437
Practice Address - Fax:870-239-4211
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR55711OtherBLUE CROSS
AR121765001Medicaid
ARF35261Medicare UPIN