Crockett, Tanya Ezell
Crockett, Tanya Ezell is an individual health care provider with primary practice located at 496 Southland Dr , Lexington KY 40503-1827. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Crockett, Tanya Ezell can be contacted via phone (859) 288-2425.Contact Information
Primary practice address
496 Southland Dr
Lexington KY 40503-1827
Phone: (859) 288-2425
Fax: (859) 721-3918
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 3007181 | Kentucky |
Profile Details
| NPI number | 1740564954 |
|---|---|
| LBN Legal business name | Crockett, Tanya Ezell |
| Credentials | APRN, CPNP-PC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 6th, 2011 |
| Last updated | May 22nd, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740564954 | NPPES |
| Kentucky | MEDICAID | 7100197040 |
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