Individual
MS. RENITA L. CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
227 FALCON DR # 101, MT STERLING, KY 40353-9792
(859) 497-5135
(859) 497-5140
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7835
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA096
KY
363AM0700X
Medical Physician Assistant
PA096
KY
363AS0400X
Surgical Physician Assistant
PA096
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
95002556
—
KY
01
—
970025767
RR MEDICARE PIN
GA
01
—
CB5773
RR MEDICARE GROUP
GA
Enumeration date
10/02/2006
Last updated
01/30/2023
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