Provider Demographics
NPI:1457642266
Name:CRUMBAKER, ANNIE JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:JEAN
Last Name:CRUMBAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:JEAN
Other - Last Name:CAFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-9574
Mailing Address - Country:US
Mailing Address - Phone:785-889-4274
Mailing Address - Fax:785-889-7163
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:KS
Practice Address - Zip Code:66549-9684
Practice Address - Country:US
Practice Address - Phone:785-457-9890
Practice Address - Fax:785-457-9891
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
130520019OtherMEDICARE
KS200734630DMedicaid