Individual
JASON WESLEY CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
250967
NC
207RX0202X
Medical Oncology Physician
Primary
5009668
NC
363LF0000X
Family Nurse Practitioner
5009668
NC
Other
Enumeration date
12/23/2016
Last updated
09/17/2019
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