Individual
CARLA JEANNE CROCKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP/PMHNP
Contact information
Practice address
7600 NE 41ST ST STE 203, VANCOUVER, WA 98662-6772
(360) 253-6425
(360) 253-3196
Mailing address
7600 NE 41ST ST STE 203, VANCOUVER, WA 98662-6772
(360) 253-6425
(360) 253-3196
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
200450092NP PMHNP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP30006594
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
831447012
BLUE CROSS BLUE SHIELD
OR
Enumeration date
07/15/2006
Last updated
10/16/2024
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