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NPI Code Detail

MEDICARE: STEPHEN A CROCKETT

MEDICARE: STEPHEN A CROCKETT
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
1164W00000XLicensed Practical Nurse133319OH

General Provider Information

NPI Number : 1457749137
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN A CROCKETT
Provider Business Mailing Address
First Line : 9932 GREENRIVER DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-2012
Country : US
Telephone Number : 513-518-9028
Fax Number :
Provider Business Practice Location Address
First Line : 9932 GREENRIVER DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-2012
Country : US
Telephone Number : 513-518-9028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2015
Last Update Date : 02/09/2015

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Directions to “ STEPHEN A CROCKETT ” Practice Location

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