Provider Demographics
NPI:1558784728
Name:CROWDER, RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:CROWDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 E STEARNS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6243
Mailing Address - Country:US
Mailing Address - Phone:479-718-7546
Mailing Address - Fax:
Practice Address - Street 1:1444 E STEARNS ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6243
Practice Address - Country:US
Practice Address - Phone:479-718-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant