Individual
MRS. JULIE B CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3620 JOSEPH SIEWICK DR STE 100, FAIRFAX, VA 22033-1757
(540) 892-6217
Mailing address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001036
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346235843
UMWA
VA
01
—
371194700
BLACK LUNG
VA
01
—
540506332108
TRICARE/CHAMPUS
VA
01
—
P00359240
RAILROAD MEDICARE
VA
Enumeration date
09/12/2005
Last updated
01/12/2023
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