Charley Crockett

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6819 Issued in TN

Practice address

2702 Jacksboro Pike
Jacksboro, TN 37757-4850

Phone

(423) 374-7775

Fax

(423) 374-7779

NPI assigned

Oct 13, 2025

Last updated

Jan 14, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Lincoln Memorial University Medical Department, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Access Medical Clinic LLCGroup PAC ID 1951721802, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Access Medical Clinic LLC

  dba Access Medical Clinic

  • Rural Health Clinic/Center
  • Gatlinburg, TN
  • NPI 1023621646
  Medicare reassignment Care Compare group NPD (past)
• Velocity Medical LLC

  dba Neighborhood Urgent Care

  • Psychiatric/Mental Health Nurse Practitioner
  • New Castle, KY
  • NPI 1013352269

  TN

  Medicare reassignment NPD
• Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Jacksboro, TN
  • NPI 1114881117
  NPD
• Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Clinton, TN
  • NPI 1215891098
  NPD
• Access Medical Clinic LLC

  dba Access Medical Clinic

  • Rural Health Clinic/Center
  • Crawfordsville, IN
  • NPI 1831810431
  NPD (past)

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

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768348800000",
    "number": "1376419960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 JACKSBORO PIKE",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "377574850",
            "telephone_number": "423-374-7775",
            "fax_number": "423-374-7779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Tanner Pl",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "TN",
            "postal_code": "377166684",
            "country_code": "US",
            "telephone_number": "865-855-3500",
            "fax_number": "865-855-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "CHARLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-13",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "6819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Family Dentistry
• Community Health of East Tennessee Inc (CHET Behavioral Wellness)
• Community Health of East Tennessee, Inc
• Compassionate Home Health Care LLC
• Compassionate Home Health Care, LLC
• Felicia Adele Crockett, LMSW, CSW
• Crossroads Treatment Centers of Tennessee, PC
• Pamela G Davis, NP
• Tonya L. Davis, FNP
• Subanithya Dhamotharan, M.D.

• Physician Assistant in Jacksboro, TN
• Providers in Jacksboro, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.