Provider Demographics
NPI:1124386446
Name:CRAIG, YINGRAO (PA)
Entity Type:Individual
Prefix:
First Name:YINGRAO
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-377-9200
Mailing Address - Fax:972-377-9300
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-377-9200
Practice Address - Fax:972-377-9300
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3034670-01Medicaid
TXTXB155569Medicare PIN