Provider Demographics
NPI:1205998978
Name:CRABTREE, JUDITH KAY (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAY
Last Name:CRABTREE
Suffix:
Gender:F
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0339
Mailing Address - Country:US
Mailing Address - Phone:530-926-4528
Mailing Address - Fax:530-926-5070
Practice Address - Street 1:824 PINE ST
Practice Address - Street 2:
Practice Address - City:MT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067
Practice Address - Country:US
Practice Address - Phone:530-926-4528
Practice Address - Fax:530-926-5070
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner