Provider Demographics
NPI:1871878967
Name:CROUSE, GEORGE (FNP-BC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:CROUSE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BROOKMAN DR EXT
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2371
Mailing Address - Country:US
Mailing Address - Phone:601-823-5275
Mailing Address - Fax:601-823-2206
Practice Address - Street 1:601 BROOKMAN DR EXT
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2371
Practice Address - Country:US
Practice Address - Phone:601-823-5275
Practice Address - Fax:601-823-2206
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily