Cortney Crocker, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704271709 Issued in MI

Practice address

205 Grove St
Mancelona, MI 49659-8018

Phone

(231) 587-9840

Fax

(231) 587-9846

NPI assigned

Jan 5, 2016

Last updated

Jul 21, 2021By 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 3

Addresses

Other names 1

• Cortney Shumway Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Grand Traverse Children's Clinic

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1750398871
  NPD (past)

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1649636853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W GARFIELD AVE",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201631",
            "telephone_number": "231-547-6523",
            "fax_number": "231-547-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 GROVE ST",
            "city": "MANCELONA",
            "state": "MI",
            "postal_code": "496598018",
            "telephone_number": "231-587-9840",
            "fax_number": "231-587-9846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "CORTNEY",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-05",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "HI",
            "license": "2529",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2015039036",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704271709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORTNEY",
            "last_name": "SHUMWAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Destiny Sally-Kay Adams
• Albert C Brown, M.D.
• Amy Cannon
• Cedar Run Family Medicine Center
• Cassie A. Craft
• Amanda Marie Desjardins, DDS
• Katherine J Ducharme, PA-C
• Richelle Dugyon
• Family Fare, LLC (Family Fare Pharmacy 1507)
• Kenedy Fomenko, D.M.D

• Pediatric Nurse Practitioner in Mancelona, MI
• Providers in Mancelona, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.