Healthcare Provider Details

I. General information

NPI: 1477907798
Provider Name (Legal Business Name): LAUREN CROCKETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK SURGERY CLINIC - GENERAL 740 S LIMESTONE STE L104
LEXINGTON KY
40536
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3253
  • Fax: 859-257-7603
Mailing address:
  • Phone: 606-330-7818
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010169
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: