Maryliz Crockett

Primary specialty

School Registered NurseTaxonomy code 163WS0200X

License

R024581 Issued in SD

Practice address

110 N Mentzer St
Mitchell, SD 57301-8001

Phone

(605) 995-3021

NPI assigned

Jun 3, 2016

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

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": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1902255698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N MENTZER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573018001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N MENTZER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573018001",
            "telephone_number": "605-995-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "MARYLIZ",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "SD",
            "license": "R024581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Mitchell/Palace Transit
• Erika Nicole Clark, OTD, OTR/L
• Jessica Claussen, MD
• Collaborative Solutions, LLC
• Complete Wellness Clinic, Inc.
• Dailey Dental Inc
• Matthew J Dailey, DDS
• Dakota Counseling Institute
• Dakota Counseling Institute, Inc.
• Dakota Family Chiropractic of Mitchell PC

• All providers in Mitchell, SD
• School Registered Nurse in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.