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1750711172

NPI Code Detail

MEDICARE: CRAIG PERRIEN AGACNP

MEDICARE: CRAIG PERRIEN AGACNP

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	363LG0600X	Gerontology Nurse Practitioner	AP125105	TX
2	363LG0600X	Gerontology Nurse Practitioner	717836	TX
3	363LC0200X	Critical Care Medicine Nurse Practitioner	AP125105	TX
4	363L00000X	Nurse Practitioner	717836	TX
5	363LC0200X	Critical Care Medicine Nurse Practitioner	717836	TX
6	363L00000X	Nurse Practitioner	AP125105	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750711172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG PERRIEN AGACNP

Provider Business Mailing Address
First Line	:	PO BOX 840020
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0020
Country	:	US
Telephone Number	:	806-212-5079
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 W 9TH AVE
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1701
Country	:	US
Telephone Number	:	806-358-0200
Fax Number	:	806-356-5590

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

Provider Enumeration Date	:	11/21/2013
Last Update Date	:	01/22/2026

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Practice Location Address:

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1659577013 — MARCIA HEATHER HENDERSON MD
Practice Location Address:

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1023278603 — THIEN TOAN VO M.D.
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Practice Location Address:

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1679766604 — MING CHEN M.D., PH.D.
Practice Location Address:

6700 W 9TH AVE
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79106-1701

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1770766453 — MARY ALANA ELMQUIST GNP
Practice Location Address:

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Directions to “ CRAIG PERRIEN AGACNP” Practice Location

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