Provider Demographics
NPI:1447860655
Name:CRAWFORD, COURTNEY TAYLOR (LVN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-2447
Mailing Address - Country:US
Mailing Address - Phone:903-258-4502
Mailing Address - Fax:
Practice Address - Street 1:421 CLARK ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2447
Practice Address - Country:US
Practice Address - Phone:903-258-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333180164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse