Provider Demographics
NPI:1205393709
Name:AB CRAIG APRN LLC
Entity Type:Organization
Organization Name:AB CRAIG APRN LLC
Other - Org Name:ABC WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-401-4686
Mailing Address - Street 1:402 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5508
Mailing Address - Country:US
Mailing Address - Phone:337-401-4686
Mailing Address - Fax:337-201-3054
Practice Address - Street 1:402 W 8TH ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-5508
Practice Address - Country:US
Practice Address - Phone:337-401-4686
Practice Address - Fax:337-201-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2401831Medicaid
LA2478605Medicaid