Jan Leslie Crean, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

036135 Issued in TN

Practice address

603 Lake Way PL
Suite B
Tullahoma, TN 37388-4740

Phone

(931) 455-1177

Fax

(931) 461-3091

NPI assigned

Mar 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1790744456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 LAKE WAY PL",
            "address_2": "SUITE B",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373884740",
            "telephone_number": "931-455-1177",
            "fax_number": "931-461-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 LAKE WAY PL",
            "address_2": "SUITE B",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373884740",
            "telephone_number": "931-455-1177",
            "fax_number": "931-461-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREAN",
        "first_name": "JAN",
        "middle_name": "LESLIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-21",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "036135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4252143",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Tullahoma, TN
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.