Provider Demographics
NPI:1912311911
Name:CROCKETT, ELIZABETH MALONEY (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MALONEY
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1760
Mailing Address - Country:US
Mailing Address - Phone:423-790-7662
Mailing Address - Fax:
Practice Address - Street 1:463 1ST ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1760
Practice Address - Country:US
Practice Address - Phone:423-790-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily