Provider Demographics
NPI:1891749750
Name:CRUTCHFIELD, HOLLIE G (CRNP)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:G
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-793-5672
Mailing Address - Fax:334-794-0378
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 403
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-793-5672
Practice Address - Fax:334-794-0378
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1088734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520456OtherBCBS OF AL #
AL051551009Medicaid
AL051551009Medicare ID - Type UnspecifiedMEDICARE #
ALP39091Medicare UPIN