Provider Demographics
NPI:1831354109
Name:CRAWFORD, COLLEEN M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:FINEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:21037 PHILLIPSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507
Mailing Address - Country:US
Mailing Address - Phone:484-459-8118
Mailing Address - Fax:850-474-8096
Practice Address - Street 1:8333 N. DAVIS HIGHWAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8121
Practice Address - Fax:850-474-8096
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107885363AM0700X
ALPA.1381363AM0700X
KS15-01537363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200970330AMedicaid
KS15-01537OtherKS LICENSE
KSKA1610042OtherMEDICARE PTAN