Healthcare Provider Details

I. General information

NPI: 1992077713
Provider Name (Legal Business Name): ALONDA E. CROCKETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALONDA E MCFARLAND

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 RIDGE RD
ROCKWALL TX
75032-5804
US

IV. Provider business mailing address

2012 WELLINGTON PT
HEARTLAND TX
75126-8288
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax: 217-709-2345
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130477
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877248
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: