Provider Demographics
NPI:1851118657
Name:MCCRAW, KAYLEA BYRD
Entity type:Individual
Prefix:
First Name:KAYLEA
Middle Name:BYRD
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6519
Mailing Address - Country:US
Mailing Address - Phone:662-627-2973
Mailing Address - Fax:662-627-2973
Practice Address - Street 1:705 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6519
Practice Address - Country:US
Practice Address - Phone:662-627-2973
Practice Address - Fax:662-624-5595
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily