Provider Demographics
NPI:1487232781
Name:CRAYCRAFT, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CRAYCRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:WV
Mailing Address - Zip Code:25972-0672
Mailing Address - Country:US
Mailing Address - Phone:304-618-3815
Mailing Address - Fax:
Practice Address - Street 1:3498 COALFIELD TRIAL
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:WV
Practice Address - Zip Code:25972
Practice Address - Country:US
Practice Address - Phone:304-618-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker