Provider Demographics
NPI:1518542117
Name:CRAWFORD, KRYSTA LYN (DNP)
Entity Type:Individual
Prefix:DR
First Name:KRYSTA
Middle Name:LYN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MISS
Other - First Name:KRYSTA
Other - Middle Name:LYN
Other - Last Name:SPIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8829 W GLENN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6903
Mailing Address - Country:US
Mailing Address - Phone:623-521-0274
Mailing Address - Fax:
Practice Address - Street 1:8829 W GLENN DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-6903
Practice Address - Country:US
Practice Address - Phone:623-521-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247582363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics