Doctor Name: | ASHLEY MARISSA CRADDOCK |
NPI Number: | 1851780597 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R882607 |
Business Practice Address: | 3102 Goodman Rd W Horn Lake, MS - 386371172 |
Business Phone Number: | 6623426676 |
Business Fax Number: | |
Mailing Address: | 3102 Goodman Rd W, HORN LAKE |
State: | MS |
Postal Code: | 386371172 |
Phone Number: | 6623426676 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2015 |
NPI Last Update Date: | 01/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R882607 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |