Provider Demographics
NPI:1003087289
Name:MCCRANEY, ERIC ASHLEY (CRNP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ASHLEY
Last Name:MCCRANEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1007
Mailing Address - Country:US
Mailing Address - Phone:251-690-8891
Mailing Address - Fax:251-544-0188
Practice Address - Street 1:1017 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-9105
Practice Address - Country:US
Practice Address - Phone:601-947-1330
Practice Address - Fax:601-947-1331
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-092412363LF0000X
MSR863289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011846OtherMEDICARE GROUP NUMBER
MS05523153Medicaid
AL1063439065OtherNPI SITE GROUP PAYEE NUMBER
AL630000013Medicaid
MS302I502427Medicare PIN