Provider Demographics
NPI:1699316893
Name:CROW, RACHAEL JEAN
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:JEAN
Last Name:CROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4111 C ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4053
Mailing Address - Country:US
Mailing Address - Phone:501-442-6744
Mailing Address - Fax:
Practice Address - Street 1:4111 C ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4053
Practice Address - Country:US
Practice Address - Phone:501-442-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3747A0650XOtherDEPARTMENT OF VETERANS AFFAIRS