Kenneth Adams Crockett Jr., PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601001028 Issued in MI

Practice address

1890 S US Highway 131
Suite 4
Petoskey, MI 49770-8344

Phone

(231) 487-2000

NPI assigned

Jul 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GJDJBA/Endpoint/GJDJBA

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1053338830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 S US HIGHWAY 131",
            "address_2": "SUITE 4",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708344",
            "telephone_number": "231-487-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 S US HIGHWAY 131",
            "address_2": "SUITE 4",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708344",
            "telephone_number": "231-487-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "KENNETH",
        "middle_name": "ADAMS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601001028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "KC001028",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Clyde Cox, MD
• Carrie R Crawford, OTR/L
• Pamela A Crawford, CRNA
• Crockett Rehabilitation Services (Empowering the Best LLC)
• Carla Crockett, MS, OTRL
• Tina M Crook, PA-C
• William F Crook, P.A.
• Spencer Cross, DNP
• Amy Cullen, M.S. CCCA
• Joanne Louise Culver, MSPT

• Medical Physician Assistant in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.