Provider Demographics
NPI:1194878611
Name:CROSON, AMY L (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CROSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 269084
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9084
Mailing Address - Country:US
Mailing Address - Phone:731-394-1145
Mailing Address - Fax:
Practice Address - Street 1:3090 FIVE POINTS HARTFORD RD
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:OH
Practice Address - Zip Code:44418-9726
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:330-971-7256
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH274464163W00000X
OHAPRN.CNP.18926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse