Provider Demographics
NPI:1891800876
Name:CRAWFORD, PETER S (APRN,FNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:S
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13724 KIMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-4515
Mailing Address - Country:US
Mailing Address - Phone:225-756-3181
Mailing Address - Fax:
Practice Address - Street 1:15825 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1497
Practice Address - Country:US
Practice Address - Phone:985-429-1080
Practice Address - Fax:985-429-1092
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1163287Medicaid
LA4C778Medicare ID - Type Unspecified
LA1163287Medicaid