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General NPI Number Information
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NPI Number | 1720457609
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Entity Type | Individual
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Provider Name | TRACI CRAIG PNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 345 STONE AVE
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City | PARIS
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State | TX
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Zip | 75460-9309
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Country | US
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Telephone | 903-280-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 345 STONE AVE
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City | PARIS
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State | TX
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Zip | 75460-2091
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Country | US
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Telephone | 903-280-7716
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 763673
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP129199
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License Number State | TX
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