Provider Demographics
NPI:1184046336
Name:CRAWLEY, MICHELE DIANE (APRN, CNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIANE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DIANE
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-3893
Mailing Address - Country:US
Mailing Address - Phone:918-652-9650
Mailing Address - Fax:918-652-7827
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-3893
Practice Address - Country:US
Practice Address - Phone:918-652-9650
Practice Address - Fax:918-652-7827
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84737363LF0000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200532420AMedicaid
OK338262YLV0Medicare PIN