| Doctor Name: | JACKIE LYNNE CRAFT |
| NPI Number: | 1407290596 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 0024170808 |
| Business Practice Address: | 373 Cecil D Quillen Dr Ste 101 373 Cecil D. Quillen Drive Suite 101 Duffield, VA - 242444085 |
| Business Phone Number: | 2764311638 |
| Business Fax Number: | |
| Mailing Address: | 373 Cecil D Quillen Dr Ste 101, Regional Health Resources DUFFIELD |
| State: | VA |
| Postal Code: | 242444085 |
| Phone Number: | 2764311638 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2013 |
| NPI Last Update Date: | 04/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 0024170808 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |