Healthcare Provider Details

I. General information

NPI: 1508782137
Provider Name (Legal Business Name): CAROLINE MCCRACKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

1960 RIVER INN LN
CHARLOTTESVILLE VA
22901-6203
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-7000
  • Fax:
Mailing address:
  • Phone: 314-246-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number159593
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: