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NPI Code Detail

MEDICARE: BRIDGET R CROCKETT ANP

MEDICARE: BRIDGET R CROCKETT ANP
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
1363L00000XNurse PractitionerATP-000160AR
2363LF0000XFamily Nurse PractitionerA03144AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952566440
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET R CROCKETT ANP
Provider Business Mailing Address
First Line : 112 BRANTLEY RD
Second Line :
City : SEARCY
State : AR
Zip : 72143-8315
Country : US
Telephone Number : 501-268-6102
Fax Number : 501-268-4445
Provider Business Practice Location Address
First Line : 112 BRANTLY ROAD
Second Line :
City : SEARCY
State : AR
Zip : 72143-6113
Country : US
Telephone Number : 501-268-6102
Fax Number : 501-268-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2008
Last Update Date : 03/24/2016

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Directions to “ BRIDGET R CROCKETT ANP” Practice Location

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