Provider Demographics
NPI:1114646585
Name:CROSBY, RONTETTA R (NP)
Entity Type:Individual
Prefix:
First Name:RONTETTA
Middle Name:R
Last Name:CROSBY
Suffix:
Gender:F
Credentials:NP
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 16206
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70616-6206
Mailing Address - Country:US
Mailing Address - Phone:337-853-8381
Mailing Address - Fax:
Practice Address - Street 1:5800 CAMPUS CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2701
Practice Address - Country:US
Practice Address - Phone:337-965-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily