Provider Demographics
NPI:1467244988
Name:CROCKETT, WHITNEY (QIDP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 W IZABELLA CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1415
Mailing Address - Country:US
Mailing Address - Phone:208-949-1407
Mailing Address - Fax:
Practice Address - Street 1:2103 W IZABELLA CT
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1415
Practice Address - Country:US
Practice Address - Phone:208-949-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist