Provider Demographics
NPI:1497743264
Name:CRONKRIGHT, HOLLY AYN (PAC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:AYN
Last Name:CRONKRIGHT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:AYN
Other - Last Name:SWEARINGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2782 S OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9404
Mailing Address - Country:US
Mailing Address - Phone:989-497-2500
Mailing Address - Fax:989-732-6577
Practice Address - Street 1:2782 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9404
Practice Address - Country:US
Practice Address - Phone:989-497-2500
Practice Address - Fax:989-732-6577
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00214270OtherRAILROAD MEDICARE
MI010G27604OtherBCBS OF MICHIGAN
1010143OtherMCLAREN HEALTH PLAN
139500OtherGREAT LAKES HEALTH PLAN
MI253OtherCOMMUNITY CHOICE
MI080G310660OtherBCBS MI
1010143OtherHEALTH ADVANTAGE
MI3500576OtherMOLINA HEALTH CARE
139500OtherGREAT LAKES HEALTH PLAN
MI3500576OtherMOLINA HEALTH CARE
P16234Medicare UPIN