Provider Demographics
NPI:1790545069
Name:CRABTREE, CANDI
Entity Type:Individual
Prefix:
First Name:CANDI
Middle Name:
Last Name:CRABTREE
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 1:149 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:149 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65571
Practice Address - Country:US
Practice Address - Phone:417-932-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily