Provider Demographics
NPI:1841234051
Name:CROFT, CHRISTIE JILL (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:JILL
Last Name:CROFT
Suffix:
Gender:F
Credentials:APRN
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 1079
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1079
Mailing Address - Country:US
Mailing Address - Phone:270-827-0353
Mailing Address - Fax:270-827-4966
Practice Address - Street 1:9064 US HWY 60 W
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:KY
Practice Address - Zip Code:42459
Practice Address - Country:US
Practice Address - Phone:270-333-4349
Practice Address - Fax:270-333-9292
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004847363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78016961Medicaid
KY78016961Medicaid
KYP00429107Medicare PIN
KY0627307Medicare PIN
KY0627406Medicare PIN
KYQ71792Medicare UPIN