Crockett, Teresa

Crockett, Teresa is an individual health care provider with primary practice located at 12 East Brunswick , Byhalia MS 38611. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Crockett, Teresa can be contacted via phone (662) 838-2163.

Contact Information

Primary practice address
12 East Brunswick Byhalia MS 38611
Phone: (662) 838-2163
Fax: (662) 838-7944
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R538248 Mississippi

Profile Details

NPI number 1770587388
LBN Legal business name Crockett, Teresa
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770587388 NPPES
Mississippi MEDICAID 0015390

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