Provider Demographics
NPI:1851941397
Name:CRENSHAW, KINA COUSIN
Entity type:Individual
Prefix:
First Name:KINA
Middle Name:COUSIN
Last Name:CRENSHAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KINA
Other - Middle Name:COUSIN
Other - Last Name:HOOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3209 MIDTOWN PARK S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4126
Mailing Address - Country:US
Mailing Address - Phone:251-525-9090
Mailing Address - Fax:251-525-9091
Practice Address - Street 1:1015 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1713
Practice Address - Country:US
Practice Address - Phone:251-525-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health