Everett James Crockett, PHAI.IR.61593108
Student in an Organized Health Care Education/Training Program in Spokane, WA. Individual provider (NPI-1).
NPI number1104762012
StatusActive
Last updated in NPPESApr 24, 2026
Details
- NPI
- 1104762012
- Entity type
- Individual (NPI-1)
- Name
- Everett James Crockett
- Credential
- PHAI.IR.61593108
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 24, 2026
- Certification date
- Apr 20, 2026
- Last updated
- Apr 24, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | PHAI.IR.61593108 | WA | Yes |
Practice location
205 E Spokane Falls BlvdSpokane, WA 99202
Phone 509-368-6700
Mailing address
205 E Spokane Falls BlvdSpokane, WA 99202
Phone 509-368-6700
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