Provider Demographics
NPI:1518374024
Name:MANDY CRAWFORD FAMILY PRACTICE PLC
Entity Type:Organization
Organization Name:MANDY CRAWFORD FAMILY PRACTICE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-478-4963
Mailing Address - Street 1:2315 MAYFAIR DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4557
Mailing Address - Country:US
Mailing Address - Phone:270-478-4963
Mailing Address - Fax:270-478-4965
Practice Address - Street 1:2315 MAYFAIR DR
Practice Address - Street 2:SUITE 16
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4557
Practice Address - Country:US
Practice Address - Phone:270-478-4963
Practice Address - Fax:270-478-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty