Basic Information
| Provider Information | |||||||||
| NPI: | 1962987586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8 | ||||||||
| Address2: | |||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713680008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183894028 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 CHISUM ST | ||||||||
| Address2: | |||||||||
| City: | SICILY ISLAND | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713684807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183895727 | ||||||||
| FaxNumber: | 3183894028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP10048 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.