Provider Demographics
NPI:1164448155
Name:MUELLER, CRAIG DAVID (FNP)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DAVID
Last Name:MUELLER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-791-9120
Mailing Address - Fax:903-791-9132
Practice Address - Street 1:5212 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-5930
Practice Address - Country:US
Practice Address - Phone:903-831-6848
Practice Address - Fax:903-223-7089
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652397363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR82827OtherBLUE SHIELD
TX167645401Medicaid
TX8N7142OtherBLUE SHIELD
OK200035390AMedicaid
AR154712758Medicaid
TX8C1184Medicare ID - Type Unspecified
AR82827OtherBLUE SHIELD
AR154712758Medicaid