Healthcare Provider Details

I. General information

NPI: 1982684676
Provider Name (Legal Business Name): PATRICK G NORTHCRAFT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 AMHERST ST STE F
WINCHESTER VA
22601-2841
US

IV. Provider business mailing address

1870 AMHERST ST STE F
WINCHESTER VA
22601-2841
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-0010
  • Fax:
Mailing address:
  • Phone: 540-536-0110
  • Fax: 540-536-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60297
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024165477
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: