Provider Demographics
NPI:1326121997
Name:SCRAGG, CHRISTINA (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SCRAGG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 PEACHARBOR LANE
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320
Mailing Address - Country:US
Mailing Address - Phone:304-984-1169
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKIE AVENUE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4077
Practice Address - Fax:304-388-9852
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58904163W00000X
WV71758367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002244Medicaid
WVP00219164OtherRR MEDICARE
WVP00219164OtherRR MEDICARE