MEDICARE: STEVEN CROGHAN NP

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	363LF0000X	Family Nurse Practitioner	0024174317	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024174317	VA
3	363LF0000X	Family Nurse Practitioner	32154	TN

General Provider Information

NPI Number	:	1932646163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN CROGHAN NP

Provider Business Mailing Address
First Line	:	6215 MENDOTA RD
Second Line	:
City	:	MENDOTA
State	:	VA
Zip	:	24270-2605
Country	:	US
Telephone Number	:	766-440-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3226
Country	:	US
Telephone Number	:	423-830-0516
Fax Number	:	423-830-0517

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

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	12/15/2022

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