Provider Demographics
NPI:1699048066
Name:CRAWFORD, ELIZABETH MICHELLE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
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Mailing Address - Street 1:2 SHERIDAN SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7399
Mailing Address - Country:US
Mailing Address - Phone:423-246-8061
Mailing Address - Fax:423-246-8278
Practice Address - Street 1:2 SHERIDAN SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7399
Practice Address - Country:US
Practice Address - Phone:423-246-8061
Practice Address - Fax:423-246-8278
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN16461363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I509680Medicare PIN