Healthcare Provider Details

I. General information

NPI: 1750737748
Provider Name (Legal Business Name): ASHLEY CRATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WESTMINSTER LN
KINSTON NC
28501-2766
US

IV. Provider business mailing address

PO BOX 674
KINSTON NC
28502-0674
US

V. Phone/Fax

Practice location:
  • Phone: 252-208-8479
  • Fax: 252-686-8808
Mailing address:
  • Phone: 252-208-8479
  • Fax: 252-686-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberFCL054072
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberFCL054072
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: