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General NPI Number Information
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NPI Number | 1295396661
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Entity Type | Individual
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Provider Name | ASHLEY TRUSSELL CROOM NP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 1220 E NORTHSIDE DR STE 220
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City | JACKSON
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State | MS
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Zip | 39211-5503
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Country | US
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Telephone | 601-298-4173
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Fax | 877-866-2356
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 601-298-4173
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Fax | 877-866-2356
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 903405
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License Number State | MS
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