Provider Demographics
NPI:1245965938
Name:CROCKETT, CHASITY NICHOLE (RN)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:NICHOLE
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18824 VEA DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4007
Mailing Address - Country:US
Mailing Address - Phone:580-504-9526
Mailing Address - Fax:
Practice Address - Street 1:18824 VEA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4007
Practice Address - Country:US
Practice Address - Phone:580-504-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0123347163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory