Provider Demographics
NPI:1801899612
Name:CRAWFORD, MELISSA A (PA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:MINCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2265 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-823-8381
Mailing Address - Fax:785-823-0383
Practice Address - Street 1:2265 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-823-8381
Practice Address - Fax:785-823-0383
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200303570EMedicaid
KS200303570AMedicaid