Individual
TIMIKA ROSHAUN CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6501 DOGWOOD VIEW PKWY STE A, JACKSON, MS 39213-7857
(601) 899-3340
(601) 899-3343
Mailing address
108 VAN BUREN ST, BELZONI, MS 39038-4031
(601) 750-5153
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901859
MS
Other
Enumeration date
01/30/2017
Last updated
02/21/2022
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