Basic Information
| Provider Information | |||||||||
| NPI: | 1114904836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREWS | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | QUISENBERRY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E PARRISH AVE | ||||||||
| Address2: | BLDG B, STE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 02/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 37894 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 50002485 | 01 | KY | PASSPORT | OTHER | 65069321 | 05 | KY | MEDICAID | 000000300269 | 01 | KY | BLUE CROSS | OTHER |