1. Home
  2. Directory
  3. Kentucky
  4. Leitchfield
  5. Nurse Anesthetist Certified Registered
  6. NPI Profile
  7. NPI Record 1114442324

JARED CROCKER CRNA
Complete NPI Record 1114442324
Nurse Anesthetist, Certified Registered in Leitchfield, KY

NPI Status: Active since August 08, 2017

Contact Information

910 WALLACE AVE
LEITCHFIELD, KY
ZIP 42754
Phone: (270) 274-0480

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Credential Text
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Provider Gender Code
  20. Healthcare Provider Taxonomy Code 1
  21. Provider License Number 1
  22. Provider License Number State Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1114442324. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1114442324
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Entity Type Code: 1
The city name in the location address of the provider being identified.
The State code in the location of the provider being identified.
Provider First Name: JARED
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Credential Text: CRNA
The country code in the location address of the provider being identified.
Provider First Line Business Mailing Address: 119 JOHN AUSTIN LN
The telephone number associated with the location address of the provider being identified.
Provider Business Mailing Address City Name: MT WASHINGTON
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Mailing Address State Name: KY
The date that a record was last updated or changed.
Provider Business Mailing Address Postal Code: 400476349
The code designating the provider’s gender if the provider is a person.
Provider Business Mailing Address Country Code If outside U S : US
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider First Line Business Practice Location Address: 910 WALLACE AVE
Provider Business Practice Location Address City Name: LEITCHFIELD
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Business Practice Location Address State Name: KY
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 427542414
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2702740480
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/8/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/25/2019
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 367500000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 3013154
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: KY
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No