Individual
JACY KILLIAN CROCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
401 FERNDALE BLVD, HIGH POINT, NC 27262-4739
(336) 882-2567
(336) 882-2567
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 713-0947
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
230341
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
108810
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230341
RN
NC
Enumeration date
08/07/2015
Last updated
06/27/2025
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