Crockett, Kenneth Adams
Crockett, Kenneth Adams is an individual health care provider with primary practice located at 1890 S Us Highway 131 Suite 4, Petoskey MI 49770-8344. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Crockett, Kenneth Adams can be contacted via phone (231) 487-2000.Contact Information
Primary practice address
1890 S Us Highway 131 Suite 4
Petoskey MI 49770-8344
Phone: (231) 487-2000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 5601001028 | Michigan |
Profile Details
| NPI number | 1053338830 |
|---|---|
| LBN Legal business name | Crockett, Kenneth Adams |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 16th, 2006 |
| Last updated | Apr 18th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053338830 | NPPES |
| Michigan | Other | KC001028 | STATE LICENSE |
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