Melissa Dawn Crocker, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

712934 Issued in TX

Practice address

701 Matlock Rd
Mansfield, TX 76063-9164

Phone

(817) 453-5437

Fax

(817) 453-2714

NPI assigned

Mar 11, 2011

Last updated

Nov 19, 2012By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353283200000",
    "number": "1578861779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99371",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990371",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MATLOCK RD",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639164",
            "telephone_number": "817-453-5437",
            "fax_number": "817-453-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "MELISSA",
        "middle_name": "DAWN",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-11",
        "last_updated": "2012-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "712934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219895401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "219895402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Cox, M.S., CCC-SLP
• CPR Connection LLC
• Sonya Crawford
• Kyla Crispe, PA-C
• Charlaine Ann Crocker, RNFA
• Monica Elease Crosby, LMSW
• Crosspointe Dental and Orthodontics, Inc
• Jason Don Crowley, M.D., M.P.H.
• Jason Crumley, PHARMD.
• C Ivan E Cruz Jr., M.D.

• Pediatric Nurse Practitioner in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; 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.