Provider Demographics
NPI:1083685903
Name:CRAVEN, BICKLEY (MD)
Entity Type:Individual
Prefix:
First Name:BICKLEY
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:MD
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 888
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0888
Mailing Address - Country:US
Mailing Address - Phone:276-523-0599
Mailing Address - Fax:276-523-6480
Practice Address - Street 1:1501 3RD AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3115
Practice Address - Country:US
Practice Address - Phone:276-523-0599
Practice Address - Fax:276-523-6480
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98976Medicare UPIN