Individual
MRS. TERESA CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12 EAST BRUNSWICK, BYHALIA, MS 38611
(662) 838-2163
(662) 838-7944
Mailing address
PO BOX 698, BYHALIA, MS 38611-0698
(662) 838-2163
(662) 838-7944
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R538248
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015390
—
MS
Enumeration date
06/10/2005
Last updated
07/08/2007
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