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Individual
MRS. LADY CROCKETT
Active
Individual
MRS. LADY CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN-CNP, PMHNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
384621
OH
163W00000X
Registered Nurse
979974
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0029189
OH
Other
Enumeration date
06/15/2012
Last updated
10/12/2025
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