Provider Demographics
NPI:1295019503
Name:CRADDOCK, MARIANN M (NP)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:M
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S EVANS
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6034
Mailing Address - Country:US
Mailing Address - Phone:830-278-5604
Mailing Address - Fax:830-278-1836
Practice Address - Street 1:200 S. EVANS
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5141
Practice Address - Country:US
Practice Address - Phone:830-278-7105
Practice Address - Fax:830-278-2964
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661440363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner