Healthcare Provider Details

I. General information

NPI: 1396265427
Provider Name (Legal Business Name): WILLIAM EUGENE CRAIG II NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W 8TH ST
DERIDDER LA
70634
US

IV. Provider business mailing address

402 W 8TH ST
DERIDDER LA
70634-5508
US

V. Phone/Fax

Practice location:
  • Phone: 337-401-4686
  • Fax: 337-419-0974
Mailing address:
  • Phone: 337-401-4686
  • Fax: 337-419-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP09390
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: