Provider Demographics
NPI:1558908772
Name:CRAWFORD, KIA
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 SMITH RANCH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5201
Mailing Address - Country:US
Mailing Address - Phone:832-664-9966
Mailing Address - Fax:
Practice Address - Street 1:2404 SMITH RANCH RD STE 300
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5201
Practice Address - Country:US
Practice Address - Phone:832-664-9966
Practice Address - Fax:832-664-9929
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily