Provider Demographics
NPI:1033999495
Name:MALLORY-CRAWFORD, JANARRA KATHRYN (MSN, RN, AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:JANARRA
Middle Name:KATHRYN
Last Name:MALLORY-CRAWFORD
Suffix:
Gender:F
Credentials:MSN, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1244
Mailing Address - Country:US
Mailing Address - Phone:908-227-5047
Mailing Address - Fax:
Practice Address - Street 1:6190 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1244
Practice Address - Country:US
Practice Address - Phone:908-227-5047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223664363LA2200X, 363LC1500X, 363LF0000X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology