MR. KENNETH ADAMS CROCKETT JR. (NPI# 1053338830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053338830 |
| Entity Type | Individual |
| Full Name | MR. KENNETH ADAMS CROCKETT JR. |
| Credential | PA-C |
| Practice Address |
1890 S Us Highway 131 Suite 4 Petoskey MI 49770-8344 |
| Practice Telephone | 2314872000 |
| Mailing Telephone | 2314872000 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2008-04-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601001028 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | STATE LICENSE | KC001028 | 01 |
| Street Address |
1890 S US HIGHWAY 131 SUITE 4 |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-8344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598799785 | Michael Duane Banyai | Internal Medicine | 1890 S Us Highway 131, Suite 4, Petoskey, MI 49770-8344 | 2006-07-11 |
| 1841578564 | Quick Care Family Medical Center, PC | Clinic/Center | 1890 S Us Highway 131, Suite 4, Petoskey, MI 49770-8344 | 2011-07-29 |
| 1356520084 | Samuel F Minor | Family Medicine | 1890 S Us Highway 131, Petoskey, MI 49770-8344 | 2007-10-30 |
| 1518146257 | Scott A Hotchkiss | Family Medicine | 1890 S Us Highway 131, Petoskey, MI 49770-8344 | 2007-10-30 |
| 1902825714 | William Louis Niksch | Family Medicine | 1890 S Us Highway 131, Suite 4, Petoskey, MI 49770-8344 | 2006-07-19 |
| 1629094818 | Petoskey Urgent Care PC | Clinic/Center | 1890 S Us Highway 131, Suite 4, Petoskey, MI 49770-8344 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548639560 | Jessica Ann Wallace | Physician Assistant | 1890 Us Highway 131 Unit 4, Petoskey, MI 49770-8344 | 2015-09-21 |
| 1801081344 | Nicole Elizabeth Rataj Casady | Physician Assistant | 4170 Cedar Bluff Dr, Petoskey, MI 49770-7627 | 2007-09-07 |
| 1659438976 | Patricia Elizabeth Kelly | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2007-01-03 |
| 1447350855 | Kurt B Anderson | Physician Assistant | 3280 Woods Way Ste 1, Petoskey, MI 49770-8105 | 2006-09-25 |
| 1295074128 | Lindsay Ann Potts | Physician Assistant | 560 W Mitchell St, Suite 505, Petoskey, MI 49770-2275 | 2013-02-13 |
| 1336456102 | Ryan Planck | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2010-09-01 |
| 1447573126 | Rebecca L. Price | Physician Assistant | 560 W Mitchell St, Suite 400, Petoskey, MI 49770-2275 | 2010-03-09 |
| 1518114800 | Adam Richard Wilson | Physician Assistant | 2375 Summit Park Dr, Petoskey, MI 49770-8685 | 2008-08-19 |
| 1346406592 | Courtney Griffith-sumpter | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2008-08-06 |
| 1568559383 | Sarah A Adams | Physician Assistant | 560 W Mitchell St, Suite 400, Petoskey, MI 49770-2275 | 2006-10-05 |
| Find all providers in PETOSKEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.