Provider Demographics
NPI:1437872041
Name:CRAFTON, CHARLIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-3894
Mailing Address - Country:US
Mailing Address - Phone:601-765-6711
Mailing Address - Fax:
Practice Address - Street 1:701 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3894
Practice Address - Country:US
Practice Address - Phone:601-765-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS897824OtherMISSISSIPPI BOARD OF NURSING
MS905959OtherMISSISSIPPI BOARD OF NURSING