MEDICARE: MS. KEIMYA CROCKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1013779032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEIMYA CROCKETT

Provider Business Mailing Address
First Line	:	1490 WOODCREST AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-3453
Country	:	US
Telephone Number	:	330-318-2751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 WOODCREST AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-3453
Country	:	US
Telephone Number	:	330-318-2751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	03/02/2026

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Directions to “ MS. KEIMYA CROCKETT ” Practice Location

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