Provider Demographics
NPI:1962374488
Name:CROUCH, DONNA M
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:CROUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-0604
Mailing Address - Country:US
Mailing Address - Phone:270-994-7496
Mailing Address - Fax:812-370-3098
Practice Address - Street 1:780 KREBS STATION RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3596
Practice Address - Country:US
Practice Address - Phone:270-994-7496
Practice Address - Fax:812-370-3089
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5034172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty