CHARLEY CROCKETT
NPI 1376419960
Physician Assistant in Jacksboro, TN

Q: What is Charley Crockett's NPI number?

The NPI number for Charley Crockett is 1376419960. It was assigned to this individual provider in the NPPES registry on October 13, 2025.

Q: What is Charley Crockett's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Charley Crockett was last updated on January 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 13, 2025PECOS EnrolledAccepts Medicare Assignment

2702 JACKSBORO PIKE, JACKSBORO, TN 37757(423) 374-7775(423) 374-7779 Get Directions Write a Review

NPPES record last updated: January 14, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 14, 2026, Dec 18, 2025 (2 updates tracked since 2025).

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About Charley Crockett NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLEY CROCKETT (NPI 1376419960) is an individual physician assistant in Jacksboro, Tennessee, licensed in Tennessee (6819) and active in the NPI registry since October 2025. She is enrolled in Medicare PECOS, maintains a secondary practice location in Clinton, and is a graduate of Lincoln Memorial University Medical Department (2025).

NPPES Registry Identity

NPI1376419960

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameCHARLEY CROCKETT

Location Address2702 JACKSBORO PIKEJacksboro, TN 37757-4850

Mailing Address4196 Highway 62 412 Ste AHardy, AR 72542-8002

Phone(423) 374-7775

Fax(423) 374-7779

Sole ProprietorNo

Medical School CMSLincoln Memorial University Medical DepartmentGraduated 2025

Enumeration DateOctober 13, 2025

Last NPPES UpdateJanuary 14, 20262 updates tracked since enumeration

NPPES CertifiedJanuary 14, 2026

✔ NPI 1376419960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in TN · 6819

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

2702 JACKSBORO PIKE, Jacksboro, TN 37757

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Secondary Practice Location 1

Location 1120 Tanner PlClinton, TN 37716-6684 · Phone (865) 855-3500 · Fax (865) 855-4500

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Charley Crockett is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6305331745

PECOS Enrollment IDI20251223001166

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37757 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANTHONY BAIRD PA-C

Physician Assistant