Individual
CLAY JUSTIN CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1525 S HIGLEY RD STE 104, GILBERT, AZ 85296-5045
(480) 401-2110
(507) 519-5792
Mailing address
1525 S HIGLEY RD STE 104, GILBERT, AZ 85296-5045
(480) 401-2110
(507) 519-5792
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN197246
AZ
363L00000X
Nurse Practitioner
10050854
OR
363L00000X
Nurse Practitioner
AP70013458
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
294847
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138626
—
AZ
Enumeration date
02/20/2023
Last updated
03/23/2026
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