MEDICARE: STEPHANIE M CRACKNELL NPC

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
1	363L00000X	Nurse Practitioner	612438	TX

General Provider Information

NPI Number	:	1548256324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE M CRACKNELL NPC

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-4482
Country	:	US
Telephone Number	:	214-750-3646
Fax Number	:	214-368-1610

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 220
City	:	DALLAS
State	:	TX
Zip	:	75231-4482
Country	:	US
Telephone Number	:	214-750-3646
Fax Number	:	214-368-1610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/09/2007

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Directions to “ STEPHANIE M CRACKNELL NPC” Practice Location

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