Provider Demographics
NPI:1770356602
Name:CROCKETT, JOYCE S
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:S
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 E PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2861
Mailing Address - Country:US
Mailing Address - Phone:330-941-9094
Mailing Address - Fax:
Practice Address - Street 1:949 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2861
Practice Address - Country:US
Practice Address - Phone:330-941-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health