Healthcare Provider Details

I. General information

NPI: 1750587309
Provider Name (Legal Business Name): FARAH GAIL CRAIG PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 W TIPTON ST STE D
SEYMOUR IN
47274-2794
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-8780
  • Fax: 812-524-8746
Mailing address:
  • Phone: 614-722-4867
  • Fax: 614-722-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP.10034
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28149810A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: