Provider Demographics
NPI:1437365095
Name:CRAWFORD, JEFFREY A (CRNP,)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:CRNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25442 AL HIGHWAY 127
Mailing Address - Street 2:PO BOX 449
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-6608
Mailing Address - Country:US
Mailing Address - Phone:256-732-3712
Mailing Address - Fax:256-732-3714
Practice Address - Street 1:25442 AL HIGHWAY 127
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-6608
Practice Address - Country:US
Practice Address - Phone:256-732-3712
Practice Address - Fax:256-732-3714
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0368408-28363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009905255Medicaid
AL009905255Medicaid