Provider Demographics
NPI:1487801114
Name:CROWLEY, RACHEL AMANDA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:AMANDA
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:AMANDA
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2601 KENTUCKY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3817
Mailing Address - Country:US
Mailing Address - Phone:270-575-3113
Mailing Address - Fax:270-575-3135
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-575-3113
Practice Address - Fax:270-575-3135
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC039363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0044212Medicare PIN