Provider Demographics
NPI:1255896320
Name:CRAWFORD, CHESTER PAUL JR (LPN)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:PAUL
Last Name:CRAWFORD
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6093
Mailing Address - Country:US
Mailing Address - Phone:870-240-0444
Mailing Address - Fax:870-240-0466
Practice Address - Street 1:6263 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6093
Practice Address - Country:US
Practice Address - Phone:870-240-0444
Practice Address - Fax:870-240-0466
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL51294164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse