Provider Demographics
NPI:1437660784
Name:CROUCH, CALLIE A (NP-C)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:A
Last Name:CROUCH
Suffix:
Gender:F
Credentials:NP-C
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 503
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:TX
Mailing Address - Zip Code:79059-0503
Mailing Address - Country:US
Mailing Address - Phone:806-731-0108
Mailing Address - Fax:806-731-0758
Practice Address - Street 1:110B S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:TX
Practice Address - Zip Code:79059-3050
Practice Address - Country:US
Practice Address - Phone:806-731-0108
Practice Address - Fax:806-731-0758
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135894363L00000X, 363LF0000X
OK107789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner