Provider Demographics
NPI:1144623356
Name:CRABTREE, MICHAEL THOMAS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:55 TOMMY HINES RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-2499
Mailing Address - Country:US
Mailing Address - Phone:903-277-2238
Mailing Address - Fax:
Practice Address - Street 1:3809 E 9TH ST STE 15
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5818
Practice Address - Country:US
Practice Address - Phone:870-621-0080
Practice Address - Fax:870-621-0081
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219529363LA2100X, 363LF0000X
TXAP126578363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily