Mrs Lady Crockett, MSN, APRN-CNP, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Springdale, Ohio. Her current practice location is
1329 E Kemper Rd Ste 4220b, Springdale, Ohio. You can reach out to her office (for appointments etc.) via phone at
(513) 790-4367.
Mrs Lady Crockett is licensed to practice in Ohio (license number 0029189) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1548522436.
Provider's Profile
| Full Name | Mrs Lady Crockett |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 1329 E Kemper Rd Ste 4220b, Springdale, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1548522436
- Provider Enumeration Date: 06/15/2012
- Last Update Date: 10/12/2025
Medicare PECOS Information:
- PECOS PAC ID: 9537566716
- Enrollment ID: I20210930003085
Medical Identifiers
Medical identifiers for Mrs Lady Crockett such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1548522436 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 0029189 (Ohio) | Primary |
| 163W00000X | Registered Nurse | 979974 (New York) | Secondary |
| 163W00000X | Registered Nurse | 384621 (Ohio) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Lady Crockett allows following entities to bill medicare on her behalf.
| Entity Name | Modern Psychiatry And Wellness Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1225260888
PECOS PAC ID: 6608029962
Enrollment ID: O20130117000157 |
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| Entity Name | Thrive Counseling Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215181300
PECOS PAC ID: 0749458420
Enrollment ID: O20210722002646 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Lady Crockett is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mrs Lady Crockett, MSN, APRN-CNP, PMHNP
1329 E Kemper Rd Ste 4220b,
Springdale, OH 45246-5100
Ph: (513) 790-4367 | Mrs Lady Crockett, MSN, APRN-CNP, PMHNP
1329 E Kemper Rd Ste 4220b,
Springdale, OH 45246-5100
Ph: (513) 790-4367 |
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