Provider Demographics
NPI:1720685852
Name:CRAW, DESSIREA (RD)
Entity Type:Individual
Prefix:MRS
First Name:DESSIREA
Middle Name:
Last Name:CRAW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:DESSIREA
Other - Middle Name:
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NDTR
Mailing Address - Street 1:5920 NW LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1307
Mailing Address - Country:US
Mailing Address - Phone:580-481-9270
Mailing Address - Fax:
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6192
Practice Address - Country:US
Practice Address - Phone:580-379-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered