Healthcare Provider Details

I. General information

NPI: 1295629673
Provider Name (Legal Business Name): EMMILEE NADINE MCCRACKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 W CHURCH ST STE 318
NEWARK OH
43055-5050
US

IV. Provider business mailing address

307 MERCHANT ST
NEWARK OH
43055-4409
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0042
  • Fax:
Mailing address:
  • Phone: 740-334-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: