Provider Demographics
NPI:1467835199
Name:CRAWFORD, BETHANY M (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARYNEL
Other - Last Name:WICKER-CRAWFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 500
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3263
Practice Address - Country:US
Practice Address - Phone:816-421-4115
Practice Address - Fax:816-421-4152
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015021357208000000X
MO2018022309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics