Healthcare Provider Details

I. General information

NPI: 1497758551
Provider Name (Legal Business Name): JANET CRADIC F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W STONE DR STE 110
KINGSPORT TN
37660-6027
US

IV. Provider business mailing address

1101 E STONE DR SUITE 2
KINGSPORT TN
37660-3384
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-3701
  • Fax: 423-224-3709
Mailing address:
  • Phone: 423-224-1110
  • Fax: 423-224-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166194
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5587
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: