Individual
JODI CAMERON CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
840 W FLOYD BAKER BLVD, GAFFNEY, SC 29341-1845
(864) 489-3300
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
232011
SC
363LF0000X
Family Nurse Practitioner
Primary
23001
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6022
—
SC
01
—
SCF6435019
MEDICARE PIN
SC
01
—
SCF6436067
MEDICARE PIN
SC
01
—
SCF6436084
MEDICARE PIN
SC
01
—
SCF6436121
MEDICARE PIN
SC
01
—
SCF643J577
MEDICARE PIN
SC
Enumeration date
11/02/2016
Last updated
03/28/2024
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