Provider Demographics
NPI:1548489453
Name:CROUSE, RICHARD SCOTT (FNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:CROUSE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2520 VALLEY CRST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2329
Mailing Address - Country:US
Mailing Address - Phone:573-778-0352
Mailing Address - Fax:573-686-3312
Practice Address - Street 1:2400 LUCY LEE PKWY
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2429
Practice Address - Country:US
Practice Address - Phone:573-686-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner