Provider Demographics
NPI:1750015087
Name:CRAWFORD, SAMANTHA FRITH (FNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:FRITH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:FRITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:959 MENGLE RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-4205
Mailing Address - Country:US
Mailing Address - Phone:318-282-9272
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:318-343-8600
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily