Active NPI
Jacy Killian Crocker, RN
- Certified Registered Nurse Anesthetist
- High Point, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 108810
- Practice address
- 401 Ferndale Blvd
High Point, NC 27262-4739 - Phone
- (336) 882-2567
- Fax
- (336) 882-2567
- NPI assigned
- Aug 7, 2015
- Last updated
- Jun 27, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 108810 | NC | Primary |
| Registered Nurse | 163W00000X | 230341 | NC |
Addresses
Primary practice location
401 Ferndale Blvd
High Point, NC 27262-4739
Mailing address
100 Kimel Forest Dr
Winston Salem, NC 27103-6074
Phone (336) 713-0947
Other practice location 1
601 N Elm St
High Point, NC 27262-4331
Phone (336) 878-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 230341 | Other | NC | RN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
601 N Elm St
High Point, NC 27262-4331
Phone (336) 716-2734
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108810 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Current | Accepting new patients | |
| Carolina Anesthesiology, PA | Current | Accepting new patients |
Locations
401 Ferndale Blvd
High Point, NC 27262
Phone (336) 882-2567
601 N Elm St
High Point, NC 27262
Phone (336) 878-6419
100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947
Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Winston Salem, NC
- NPI 1003803032
-
- Anesthesiology Physician
- High Point, NC
- NPI 1629032347
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba High Point Regional
- General Acute Care Hospital
- High Point, NC
- NPI 1396746228
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750982400000",
"number": "1528444080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KIMEL FOREST DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036074",
"telephone_number": "336-713-0947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 FERNDALE BLVD",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272624739",
"telephone_number": "336-882-2567",
"fax_number": "336-882-2567"
}
],
"practiceLocations": [
{
"address_1": "601 N Elm St",
"address_purpose": "LOCATION",
"city": "High Point",
"state": "NC",
"postal_code": "272624331",
"country_code": "US",
"telephone_number": "336-878-6000",
"fax_number": "336-878-6010",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CROCKER",
"first_name": "JACY",
"middle_name": "KILLIAN",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-07",
"last_updated": "2025-06-27",
"certification_date": "2025-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "108810",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NC",
"license": "230341",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN",
"identifier": "230341",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in High Point, NC
- Caroline Harrison Craven
- Robert C Crawford, M.D.
- Martha Berenice Creary
- Katherine Anne Creech, PT
- Brittany Ann Crisco, OTR/L
- Jazmin Arielle Cromartie-Hicks, DMD
- Sophia Cross
- Crossroads Treatment Centers of North Carolina, P.C. (Crossroads Treatment Centers High Point)
- Camille Marie Crowder
- Charles Carlos Crowell III, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.