Provider Demographics
NPI:1720536725
Name:CRAWFORD, KELBY RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELBY
Middle Name:RAE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELBY
Other - Middle Name:RAE
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-2583
Practice Address - Fax:570-887-2010
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant