Provider Demographics
NPI:1245859933
Name:CROSLEY, MITCHELL (CRNA)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:CROSLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MITCHELL
Other - Middle Name:
Other - Last Name:CROSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1509 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-1233
Mailing Address - Country:US
Mailing Address - Phone:985-515-5013
Mailing Address - Fax:
Practice Address - Street 1:745 POPLAR RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1618
Practice Address - Country:US
Practice Address - Phone:770-400-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN134638163WC0200X
MO2021024027367500000X
GAGAA-CRNA000409367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine