Provider Demographics
NPI:1518688621
Name:CROW, KATHERINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CROW
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 INNOVATION DR STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5269
Mailing Address - Country:US
Mailing Address - Phone:864-516-1170
Mailing Address - Fax:
Practice Address - Street 1:2 INNOVATION DR STE 350
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5269
Practice Address - Country:US
Practice Address - Phone:864-516-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2021103258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner