Healthcare Provider Details

I. General information

NPI: 1700417136
Provider Name (Legal Business Name): LAURIE DANIELLE CROCKETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N 13TH ST
ARTESIA NM
88210-1166
US

IV. Provider business mailing address

702 N 13TH ST
ARTESIA NM
88210-1199
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-3119
  • Fax: 575-746-4295
Mailing address:
  • Phone: 575-746-3119
  • Fax: 575-746-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: