Provider Demographics
NPI:1508462151
Name:CROCKETT, MINDY E (DNP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:E
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E HUNTERS HVN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-8169
Mailing Address - Country:US
Mailing Address - Phone:801-885-5064
Mailing Address - Fax:
Practice Address - Street 1:30 E HUNTERS HVN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-8169
Practice Address - Country:US
Practice Address - Phone:801-885-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7964680-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care