Provider Demographics
NPI:1417153727
Name:CRANK, ELIZABETH SUZANNE (MSN, APRN, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:CRANK
Suffix:
Gender:F
Credentials:MSN, APRN, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1297
Mailing Address - Country:US
Mailing Address - Phone:606-487-0776
Mailing Address - Fax:606-487-0777
Practice Address - Street 1:311 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9486
Practice Address - Country:US
Practice Address - Phone:606-487-0776
Practice Address - Fax:606-487-0777
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-05-1849133V00000X
KY3008084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK085700Medicare PIN
KY7100253040Medicaid