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General NPI Number Information
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NPI Number | 1164942694
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Entity Type | Individual
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Provider Name | JESSICA CROCKER
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Gender | Female
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 4200 REGENT ST STE 200
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City | COLUMBUS
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State | OH
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Zip | 43219-6229
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Country | US
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Telephone | 877-870-1775
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Fax | 614-968-8840
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Provider Business Mailing Address
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Address Line | 16401 POPLAR AVE
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City | KANSAS CITY
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State | MO
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Zip | 64136-1287
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Country | US
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Telephone | 816-519-0326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2017021767
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015040563
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14-123272-031
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License Number State | KS
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