Healthcare Provider Details

I. General information

NPI: 1730488669
Provider Name (Legal Business Name): LINDSAY T CROCKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 PHYSICIANS DR
JACKSON TN
38305-2071
US

IV. Provider business mailing address

PO BOX 457
LEXINGTON TN
38351-0457
US

V. Phone/Fax

Practice location:
  • Phone: 731-256-0526
  • Fax: 731-256-1720
Mailing address:
  • Phone: 731-968-4477
  • Fax: 731-967-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015678
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: