Individual
MR. KENNETH ADAMS CROCKETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1890 S US HIGHWAY 131, SUITE 4, PETOSKEY, MI 49770-8344
(231) 487-2000
Mailing address
1890 S US HIGHWAY 131, SUITE 4, PETOSKEY, MI 49770-8344
(231) 487-2000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601001028
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KC001028
STATE LICENSE
MI
Enumeration date
07/16/2006
Last updated
04/18/2008
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