Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G4942 | TX |
N | 111NI0900X | Internist | G4942 | TX |
Y | 207RH0003X | Hematology & Oncology | G4942 | TX |
NPI | 1063428126 |
---|---|
Provider Name | Kathleen Crowley |
First Address | Fort Worth, TX 76104-7657 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128094306 | (05) | TX |
128094307 | (05) | TX |
8B5599 | BCBS (01) | TX |
E38831 | (02) | TX |
P00312848 | RAILROAD MEDICARE PIN (01) | TX |