Provider Demographics
NPI:1588642318
Name:CROW, NANNETTE F (MD)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:F
Last Name:CROW
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 PARKER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3240
Mailing Address - Country:US
Mailing Address - Phone:214-803-2769
Mailing Address - Fax:
Practice Address - Street 1:2125 W SOUTHLAKE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6758
Practice Address - Country:US
Practice Address - Phone:817-680-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7416208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043467204Medicaid
TX043467204Medicaid