Crockett, Robert David

Crockett, Robert David is an individual health care provider with primary practice located at 1100 N College Ave , Fayetteville AR 72703-1944. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Crockett, Robert David can be contacted via phone (615) 355-3451.

Contact Information

Primary practice address
1100 N College Ave Fayetteville AR 72703-1944
Phone: (615) 355-3451
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 2000160927 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2000160927 Missouri

Profile Details

NPI number 1801883475
LBN Legal business name Crockett, Robert David
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2005
Last updated Sep 3rd, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1801883475 NPPES
Missouri MEDICAID 427473004
Missouri Other P00269324

Popular Providers