Individual
JENNA CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
730 THIMBLE SHOALS BLVD STE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
(757) 873-3239
Mailing address
730 THIMBLE SHOALS BLVD STE 130, NEWPORT NEWS, VA 23606-4562
(757) 873-1554
(757) 873-3239
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10124928P
OPTIMA HEALTH
VA
01
—
1619232519
HUMANA
VA
05
—
1619232519
—
VA
01
—
513047
BCBS SUPPLEMENT
VA
Enumeration date
07/07/2012
Last updated
04/15/2021
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