Crockford, Carla Jeanne
Crockford, Carla Jeanne is an sole proprietor health care provider with primary practice located at 1014 Main Street , Vancouver WA 98661. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Crockford, Carla Jeanne can be contacted via phone (360) 695-1014.Contact Information
Primary practice address
1014 Main Street
Vancouver WA 98661
Phone: (360) 695-1014
Fax: (360) 750-1374
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 200450092NP PMHNP-PP | Oregon |
Profile Details
| NPI number | 1467478867 |
|---|---|
| LBN Legal business name | Crockford, Carla Jeanne |
| Credentials | ARNP/PMHNP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 15th, 2006 |
| Last updated | Jan 6th, 2012 - about 12 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 | 1467478867 | NPPES |
| Oregon | Other | 831447012 | BLUE CROSS BLUE SHIELD |
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