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General NPI Number Information
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NPI Number | 1245048727
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Entity Type | Individual
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Provider Name | ANDREA LYNN CRAFT IBCLC, RN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 3692 W MARKET ST
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City | JOHNSON CITY
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State | TN
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Zip | 37604-9302
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Country | US
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Telephone | 423-737-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 204 GLEN OAKS DR
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City | JOHNSON CITY
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State | TN
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Zip | 37615-3778
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Country | US
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Telephone | 423-833-5078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 133378
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-316697
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License Number State | TN
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