Provider Demographics
NPI:1366539058
Name:CROUCH, SUSAN HELEN (MSN, ENP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HELEN
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MSN, ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 GARTH RD
Mailing Address - Street 2:#105
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3115
Mailing Address - Country:US
Mailing Address - Phone:281-837-6037
Mailing Address - Fax:281-837-8282
Practice Address - Street 1:4001 GARTH RD
Practice Address - Street 2:#105
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3115
Practice Address - Country:US
Practice Address - Phone:281-837-6037
Practice Address - Fax:281-837-8282
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645583363L00000X, 363LA2100X, 363LF0000X
TXAP114134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174535813Medicaid
TX174535805Medicaid
TX8Y8731OtherBCBSTX
TX1366539058OtherTRICARE
TX174535812Medicaid
TX8Y8731OtherBCBSTX
TX8D9322Medicare ID - Type Unspecified
TX174535813Medicaid
TXQ47959Medicare UPIN
TX174535805Medicaid
TX1366539058OtherTRICARE