Individual
KELLI LYNN CRABTREE-WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1130 W 4TH ST STE 3204, LAWRENCE, KS 66044-1345
(785) 505-5815
(785) 505-5278
Mailing address
325 MAINE STREET, MSO LIBRARY, LAWRENCE, KS 66044
(785) 505-2988
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
04-39102
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002397
MEDICARE PTAN
KS
05
—
201138420A
—
KS
05
—
30004160880001
—
KS
Enumeration date
06/24/2010
Last updated
06/20/2023
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