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General NPI Number Information
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NPI Number | 1679895296
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Entity Type | Individual
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Provider Name | ALISA ROCHELLE CRADDOCK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 906 N US HIGHWAY 421
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City | CLINTON
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State | NC
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Zip | 28328-0410
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Country | US
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Telephone | 910-592-1462
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Fax | 910-808-1040
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | FAISON
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State | NC
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Zip | 28341-0187
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Country | US
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Telephone | 910-267-2042
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Fax | 855-996-9090
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 178364
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F02241056
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License Number State | NC
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