Provider Demographics
NPI:1023032810
Name:CRAIG, CAROL B (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:CRAIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5003
Mailing Address - Country:US
Mailing Address - Phone:225-644-2100
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:1104 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5003
Practice Address - Country:US
Practice Address - Phone:225-644-2100
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN046542/AP03176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1555576Medicaid
LA5X526Medicare ID - Type Unspecified
IA1555576Medicaid