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NPI Code Detail

MEDICARE: ROBERT DAVID CROCKETT FNP

MEDICARE: ROBERT DAVID CROCKETT FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner2000160927MO
2363LF0000XFamily Nurse Practitioner2000160927MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00269324OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801883475
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT DAVID CROCKETT FNP
Provider Business Mailing Address
First Line : 2828 N NATIONAL AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65803-4306
Country : US
Telephone Number : 417-837-4000
Fax Number : 417-875-4714
Provider Business Practice Location Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 615-355-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 09/03/2019

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