Healthcare Provider Details

I. General information

NPI: 1235341363
Provider Name (Legal Business Name): KATHLEEN MCCRACKEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 S REED RD
KOKOMO IN
46902-3806
US

IV. Provider business mailing address

10845 GRIFFITH PEAK DR # 2
LAS VEGAS NV
89135-1553
US

V. Phone/Fax

Practice location:
  • Phone: 800-777-7775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000337
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: