Provider Demographics
NPI:1114950110
Name:CRAFT, LUCRETIA ROSS (RN, FNP)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:ROSS
Last Name:CRAFT
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:LU
Other - Middle Name:
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:110 EASTHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2806
Mailing Address - Country:US
Mailing Address - Phone:601-825-7905
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1588
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR134660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily