Basic Information
| Provider Information | |||||||||
| NPI: | 1841234051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROFT | ||||||||
| FirstName: | CHRISTIE | ||||||||
| MiddleName: | JILL | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1079 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424191079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708270353 | ||||||||
| FaxNumber: | 2708274966 | ||||||||
| Practice Location | |||||||||
| Address1: | 9064 US HWY 60 W | ||||||||
| Address2: | |||||||||
| City: | STURGIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703334349 | ||||||||
| FaxNumber: | 2703339292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3004847 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 3004847 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 78016961 | 05 | KY | MEDICAID |