Active NPI
Karen Elizabeth Crockett, MD
- Family Medicine Physician
- Elfrida, AZ
National Provider Identifier
1316009079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 36374
- Practice address
- 10566 N Hwy 191
Elfrida, AZ 85610-9021 - Phone
- (520) 642-2222
- Fax
- (520) 364-4261
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36374 | AZ | Primary |
Addresses
Primary practice location
10566 N Hwy 191
Elfrida, AZ 85610-9021
Mailing address
1205 F Avenue
Douglas, AZ 85607
Phone (520) 364-1429
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 169558 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370995200000",
"number": "1316009079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 F AVENUE",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "85607",
"telephone_number": "520-364-1429",
"fax_number": "520-364-4261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10566 N HWY 191",
"city": "ELFRIDA",
"state": "AZ",
"postal_code": "856109021",
"telephone_number": "520-642-2222",
"fax_number": "520-364-4261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKETT",
"first_name": "KAREN",
"middle_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2013-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "36374",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169558",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elfrida, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.