Provider Demographics
NPI:1891458212
Name:CRAZYCRE8
Entity Type:Organization
Organization Name:CRAZYCRE8
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGHNIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-608-9805
Mailing Address - Street 1:2420 CHIMNEY POINT LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4364
Mailing Address - Country:US
Mailing Address - Phone:859-608-9805
Mailing Address - Fax:
Practice Address - Street 1:2420 CHIMNEY POINT LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4364
Practice Address - Country:US
Practice Address - Phone:859-608-9805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care