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NPI Code Detail

MEDICARE: CAMERON CROCKETT OD

MEDICARE: CAMERON CROCKETT OD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOK

General Provider Information

NPI Number : 1942157284
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMERON CROCKETT OD
Provider Business Mailing Address
First Line : 265 E DUNBAR LN APT 205
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-3280
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 479-443-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ CAMERON CROCKETT OD” Practice Location

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