Provider Demographics
NPI:1346235843
Name:CROCKER, JULIE B (PA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:B
Last Name:CROCKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:3620 JOSEPH SIEWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1757
Practice Address - Country:US
Practice Address - Phone:540-892-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346235843OtherUMWA
VA371194700OtherBLACK LUNG
VA1346235843OtherCCC VIRGINIA PREMIER
VA1346235843OtherANTHEM MEDIGAP
VAP00359240OtherRAILROAD MEDICARE
VA1346235843OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1346235843OtherHUMANA MEDICARE
VA1346235843OtherINTOTAL
VA1346235843OtherOPTIMA HEALTH PLAN
VA1346235843OtherMEDICAID QMB
VA540506332108OtherTRICARE/CHAMPUS
VA1346235843OtherAETNA
VA1346235843OtherINTOTAL
VA1346235843OtherCCC VIRGINIA PREMIER