Healthcare Provider Details

I. General information

NPI: 1346692019
Provider Name (Legal Business Name): JULIE CROTTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MAIN ST
MINNEOLA KS
67865
US

IV. Provider business mailing address

222 MAIN ST PO BOX 127
MINNEOLA KS
67865
US

V. Phone/Fax

Practice location:
  • Phone: 620-885-4202
  • Fax: 620-885-4805
Mailing address:
  • Phone: 620-885-4202
  • Fax: 620-885-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77265
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: