Provider Demographics
NPI:1699953596
Name:CRAWFORD, KRISTEN (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:59 BRIAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3550
Mailing Address - Country:US
Mailing Address - Phone:716-807-4762
Mailing Address - Fax:
Practice Address - Street 1:517 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-646-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant