Individual
JACKY LYNN CRAWFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4000
(859) 258-6203
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35808
KY
2083X0100X
Occupational Medicine Physician
35808
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000184103
BLUE CROSS BLUE SHIELD
KY
05
—
64016884
—
KY
Enumeration date
06/05/2006
Last updated
04/25/2023
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