Provider Demographics
NPI:1972383552
Name:CROW, J DOUGLAS (FNP-C)
Entity type:Individual
Prefix:
First Name:J
Middle Name:DOUGLAS
Last Name:CROW
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2761
Mailing Address - Country:US
Mailing Address - Phone:817-578-0640
Mailing Address - Fax:
Practice Address - Street 1:5612 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4145
Practice Address - Country:US
Practice Address - Phone:817-632-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily