Healthcare Provider Details

I. General information

NPI: 1689597528
Provider Name (Legal Business Name): DARRELL W CROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W POTTER AVE
KIRKSVILLE MO
63501-1168
US

IV. Provider business mailing address

606 W POTTER AVE
KIRKSVILLE MO
63501-1168
US

V. Phone/Fax

Practice location:
  • Phone: 660-216-0956
  • Fax:
Mailing address:
  • Phone: 660-216-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberP-14849
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: