Individual
CHARLEY CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2702 JACKSBORO PIKE, JACKSBORO, TN 37757-4850
(423) 374-7775
(423) 374-7779
Mailing address
4196 HIGHWAY 62 412 STE A, HARDY, AR 72542-8002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6819
TN
Other
Enumeration date
10/13/2025
Last updated
01/14/2026
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