Provider Demographics
NPI:1205254216
Name:CRAWFORD, THERESA LEE (FNP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LEE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:D
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:26136 HWY 59
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-0446
Mailing Address - Country:US
Mailing Address - Phone:660-686-2211
Mailing Address - Fax:660-686-2522
Practice Address - Street 1:26136 HWY 59
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MO
Practice Address - Zip Code:64446-0446
Practice Address - Country:US
Practice Address - Phone:660-686-2211
Practice Address - Fax:660-686-2522
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000163428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily