Provider Demographics
NPI:1639500739
Name:CROCKER, KEEGAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:CROCKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KEEGAN
Other - Middle Name:
Other - Last Name:SOELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:9130 OTIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2032
Mailing Address - Country:US
Mailing Address - Phone:317-992-2910
Mailing Address - Fax:317-981-1490
Practice Address - Street 1:11650 LANTERN RD STE 134
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3101
Practice Address - Country:US
Practice Address - Phone:317-992-1988
Practice Address - Fax:317-981-1694
Is Sole Proprietor?:No
Enumeration Date:2013-11-28
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009042A363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health