Provider Demographics
NPI:1669704110
Name:CRENSHAW, MARYLYNN K (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MARYLYNN
Middle Name:K
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:KINNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6008 REGAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3319
Mailing Address - Country:US
Mailing Address - Phone:502-299-1030
Mailing Address - Fax:
Practice Address - Street 1:10510 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1228
Practice Address - Country:US
Practice Address - Phone:502-253-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002465363LF0000X, 363LP0808X
KY2465P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily