Provider Demographics
NPI:1306073416
Name:ROSS-CRAWFORD, JESSICA BROOKE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOKE
Last Name:ROSS-CRAWFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1487
Mailing Address - Country:US
Mailing Address - Phone:870-892-0027
Mailing Address - Fax:870-892-7945
Practice Address - Street 1:410 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1487
Practice Address - Country:US
Practice Address - Phone:870-892-0027
Practice Address - Fax:870-892-7945
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARR86947163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No171M00000XOther Service ProvidersCase Manager/Care Coordinator