Active NPI
Mindy Louise Crookham, NP
- Family Nurse Practitioner
- Palo Cedro, CA
National Provider Identifier
1467645382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- NP14207
- Practice address
- 10622 Petunia LN
Suite D
Palo Cedro, CA 96073-9776 - Phone
- (530) 549-4594
- NPI assigned
- Aug 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP14207 | CA | Primary |
Addresses
Primary practice location
10622 Petunia LN
Suite D
Palo Cedro, CA 96073-9776
Mailing address
10622 Petunia LN
Palo Cedro, CA 96073-9776
Phone (530) 549-4594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP14207 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Lake | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Clearlake, CA
- NPI 1326252271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401840000000",
"number": "1467645382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10622 PETUNIA LN",
"city": "PALO CEDRO",
"state": "CA",
"postal_code": "960739776",
"telephone_number": "530-549-4594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10622 PETUNIA LN",
"address_2": "SUITE D",
"city": "PALO CEDRO",
"state": "CA",
"postal_code": "960739776",
"telephone_number": "530-549-4594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROOKHAM",
"first_name": "MINDY",
"middle_name": "LOUISE",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-23",
"last_updated": "2014-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "NP14207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Cedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.