Provider Demographics
NPI:1205115425
Name:CRAWFORD, KAY MARIE (NP)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:MARIE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12441 HELENA WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2652
Mailing Address - Country:US
Mailing Address - Phone:909-931-1033
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE
Practice Address - Street 2:SUITE A-104
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-931-1033
Practice Address - Fax:909-981-8976
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily