Provider Demographics
NPI:1497519797
Name:CROCKETT, APRIL M (RN)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:M
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SILL ST
Mailing Address - Street 2:
Mailing Address - City:SPEARVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67876-8817
Mailing Address - Country:US
Mailing Address - Phone:620-253-5339
Mailing Address - Fax:
Practice Address - Street 1:2201 SUMMERLON CIR
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2985
Practice Address - Country:US
Practice Address - Phone:620-225-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS141463163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse