Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Everett James Crockett, PHAIIR61593108

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1104762012

Everett James Crockett, PHAIIR61593108 is a Student in an Organized Health Care Education/Training Program in Spokane, Washington. Practices as a sole proprietor. Licensed in Washington.

Licensed in
WA
In the registry since
2026
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Practice location Address checks out

205 E Spokane Falls Blvd
Spokane, WA 99202
Phone: (509) 368-6700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence PHAI.IR.61593108 (WA)

Record details

NPI number1104762012
Entity typeIndividual (Type 1)
GenderMale
Credentials PHAIIR61593108
Sole proprietorYes
NPI enumeratedApril 24, 2026
Last updated in NPPESApril 24, 2026
Certification dateApril 20, 2026

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