Provider Demographics
NPI:1215516083
Name:CRAWFORD, KARA ELIZABETH (PNP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:ELIZABETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COMMERCE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3118
Mailing Address - Country:US
Mailing Address - Phone:631-722-8880
Mailing Address - Fax:
Practice Address - Street 1:34 COMMERCE AVE STE 2
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3118
Practice Address - Country:US
Practice Address - Phone:631-722-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383228363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics