Individual
JARED CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
910 WALLACE AVE, LEITCHFIELD, KY 42754-2414
(270) 274-0480
Mailing address
119 JOHN AUSTIN LN, MT WASHINGTON, KY 40047-6349
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3013154
KY
Other
Enumeration date
08/08/2017
Last updated
02/25/2019
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