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NPI Code Detail

MEDICARE: ERIN CROCKETT

MEDICARE: ERIN 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
1156FX1800XOptician111849KY

General Provider Information

NPI Number : 1528798345
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN CROCKETT
Provider Business Mailing Address
First Line : 2345 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8076
Country : US
Telephone Number : 270-678-5250
Fax Number :
Provider Business Practice Location Address
First Line : 2345 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8076
Country : US
Telephone Number : 270-678-5250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2022
Last Update Date : 06/14/2022

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Directions to “ ERIN CROCKETT ” Practice Location

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