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NPI Code Detail

MEDICARE: DR. CARRIE LYNN CRAGUN-ATCHISON PH.D.

MEDICARE: DR. CARRIE LYNN CRAGUN-ATCHISON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling PsychologistPY8637FL

General Provider Information

NPI Number : 1447643648
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARRIE LYNN CRAGUN-ATCHISON PH.D.
Provider Business Mailing Address
First Line : 2523 HERSCHEL ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4509
Country : US
Telephone Number : 904-372-8141
Fax Number : 855-933-0237
Provider Business Practice Location Address
First Line : 2523 HERSCHEL ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4509
Country : US
Telephone Number : 904-372-8141
Fax Number : 855-933-0237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2015
Last Update Date : 02/05/2021

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