Individual
MRS. NICOLE LYNNE CROCKFORD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2030 NORTH CHURCH PLACE, SPARTANBURG, SC 29303
(864) 582-6858
(864) 583-9360
Mailing address
603 ADDLESTONE WAY, DUNCAN, SC 29334-8963
(864) 415-5025
(864) 583-9360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A945
SC
Other
Enumeration date
05/04/2006
Last updated
07/08/2007
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