Provider Demographics
NPI:1518409069
Name:CRAWFORD, SHAYLA (APRN, CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, CNM, WHNP-BC
Mailing Address - Street 1:4430 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-9098
Mailing Address - Country:US
Mailing Address - Phone:573-596-1770
Mailing Address - Fax:
Practice Address - Street 1:4430 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9098
Practice Address - Country:US
Practice Address - Phone:573-596-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017040750363LW0102X
MO2017010498367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health