Provider Demographics
NPI:1184240194
Name:CRUMP, JARROD VAUGHN (NP)
Entity type:Individual
Prefix:
First Name:JARROD
Middle Name:VAUGHN
Last Name:CRUMP
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 E CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8073
Mailing Address - Country:US
Mailing Address - Phone:208-818-8546
Mailing Address - Fax:
Practice Address - Street 1:1672 S WOODSAGE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8329
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health