MEDICARE: MS. NINA CRADDOLPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver
2	101YM0800X	Mental Health Counselor		OH

General Provider Information

NPI Number	:	1356071468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NINA CRADDOLPH

Provider Business Mailing Address
First Line	:	PO BOX 15404
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-0404
Country	:	US
Telephone Number	:	614-588-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 GAULT ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2933
Country	:	US
Telephone Number	:	614-216-1725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	01/23/2026

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