Individual
DR. CHETLEN CROSSNOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4515 MARSHA SHARP FWY, LUBBOCK, TX 79407-2520
(806) 744-7223
(806) 740-3325
Mailing address
4515 MARSHA SHARP FWY, LUBBOCK, TX 79407-2520
(806) 744-7223
(806) 740-3325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M0696
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148450101
TEAM CHOICE CORE (GRACE CLINIC)
TX
05
—
175472304
—
TX
01
—
7495745
AETNA
TX
01
—
8V8692
BCBS (GRACE CLINIC)
TX
Enumeration date
05/26/2006
Last updated
12/01/2021
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