Provider Demographics
NPI:1063859643
Name:CROPP, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CROPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-8476
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:229 HIGH ST
Practice Address - Street 2:
Practice Address - City:SHOALS
Practice Address - State:IN
Practice Address - Zip Code:47581-5501
Practice Address - Country:US
Practice Address - Phone:812-247-2733
Practice Address - Fax:812-247-2373
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004548A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner