Justin Yates Crockett
Individual provider Active NPI Specialist · Brattleboro, VT
NPI 1003377151 · NPPES record last updated Jul 16, 2024
Key facts
- NPI
- 1003377151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 51 Fairviewstreet
Brattleboro, VT 05301-2579 - Phone
- (802) 254-6028
- Fax
- (802) 254-7501
- NPI assigned
- Mar 29, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
51 Fairviewstreet
Brattleboro, VT 05301-2579
Mailing address
390 River Street
Springfield, VT 05156-2226
Phone (802) 886-4500
Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.