Individual
MRS. TANYA EZELL CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CPNP-PC
Contact information
Practice address
231 E CHESTNUT ST, LOUISVILLE, KY 40202-1821
(502) 629-4750
(502) 629-4617
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3007181
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100197040
—
KY
Enumeration date
10/06/2011
Last updated
02/24/2026
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