Healthcare Provider Details

I. General information

NPI: 1265984678
Provider Name (Legal Business Name): JODI CAMERON CROCKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI CAMERON BROWN NP

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W FLOYD BAKER BLVD
GAFFNEY SC
29341-1845
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-489-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number232011
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: