Provider Demographics
NPI:1992077713
Name:CROCKETT, ALONDA E (FNP)
Entity type:Individual
Prefix:
First Name:ALONDA
Middle Name:E
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALONDA
Other - Middle Name:E
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2012 WELLINGTON PT
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2911 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5804
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:217-709-2345
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130477363LF0000X
MSR877248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06157353Medicaid
TX356006203Medicaid
MS06157353Medicaid