Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9170779 | FL |
NPI | 1033126412 |
---|---|
Provider Name | Kelly Crews |
First Address | Lakeland, FL 33801-5237 |
Second Address | Lakeland, FL 33801-5237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 05/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305346600 | (05) | FL |
ARNP 9170779 | ARNP LICENSE NUMBER (01) | FL |