Kelly Crooker, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5653 Issued in AL

Practice address

950 W Coy Smith Hwy
Mount Vernon, AL 36560-3201

Phone

(251) 829-9884

Fax

(251) 829-9507

NPI assigned

Oct 3, 2006

Last updated

Mar 21, 2011By 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 3

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Mobile County Board of Health

  dba Family Oriented Primary Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mobile, AL
  • NPI 1063439065
  NPD (past)
• Mobile County Board of Health

  • State or Local Public Health Clinic/Center
  • Mobile, AL
  • NPI 1720257199
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300665600000",
    "number": "1801980511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 N BAYOU ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366035827",
            "telephone_number": "251-690-8158",
            "fax_number": "251-544-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 W COY SMITH HWY",
            "city": "MOUNT VERNON",
            "state": "AL",
            "postal_code": "365603201",
            "telephone_number": "251-829-9884",
            "fax_number": "251-829-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROOKER",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SITE NPI GROUP NUMBER",
            "identifier": "1063439065",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000013",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "011846",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Breech
• Shelby G Bruton, MD
• Kaci M Byrd Cheeseman, P.A.
• Michael Antonio Carlton, PH.D.
• Jessica Amaka Clarke, NP
• Dr John Wetzel PC
• Donna Earnshaw, M.D.
• Joel D Green, D.D.S.
• Brenda G Harvey, LCSW
• Christian S Hildreth, PSYD

• General Practice Dentistry in Mount Vernon, AL
• Providers in Mount Vernon, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.