Provider Demographics
NPI:1962267534
Name:CROW, KANDICE MAY
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:MAY
Last Name:CROW
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 1:318 HIGHLAND SPRING LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2055
Mailing Address - Country:US
Mailing Address - Phone:636-236-0338
Mailing Address - Fax:
Practice Address - Street 1:1013 W UNIVERSITY AVE STE 193
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5343
Practice Address - Country:US
Practice Address - Phone:636-236-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily