Healthcare Provider Details

I. General information

NPI: 1740259225
Provider Name (Legal Business Name): JEFFREY PAUL CRITTENDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHADOWLINE DR SUITE 202
BOONE NC
28607-5089
US

IV. Provider business mailing address

400 SHADOWLINE DR SUITE 202
BOONE NC
28607-5089
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-0600
  • Fax: 828-262-0807
Mailing address:
  • Phone: 828-262-0600
  • Fax: 828-262-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9601279
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number77
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: