Provider Demographics
NPI:1154332872
Name:MCCRAW, JIMMIE H (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JIMMIE
Middle Name:H
Last Name:MCCRAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326B SOUTH OCOTILLO
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602
Mailing Address - Country:US
Mailing Address - Phone:520-586-1015
Mailing Address - Fax:
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7251
Practice Address - Country:US
Practice Address - Phone:844-466-6827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057048163WG0000X
NMRN-71422363LF0000X
NMCNP-01648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR85521Medicare UPIN