Chyvon Nichole Crockett, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

158104 Issued in OH

Practice address

1021 W 51St St
Ashtabula, OH 44004-6725

Phone

(440) 650-4904

NPI assigned

Nov 28, 2016

Last updated

Nov 28, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1427591213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W 51ST ST",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046725",
            "telephone_number": "440-650-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W 51ST ST",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440046725",
            "telephone_number": "440-650-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "CHYVON",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "158104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BOARD OF NURSING LICENSE NUMBER",
            "identifier": "LPN 158104 M-IV",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Ashtabula, OH
• Providers in Ashtabula, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.