Provider Demographics
NPI:1497758551
Name:CRADIC, JANET (FNP)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:CRADIC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E STONE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3384
Mailing Address - Country:US
Mailing Address - Phone:423-224-1110
Mailing Address - Fax:423-224-1130
Practice Address - Street 1:111 W STONE DR STE 110
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-224-3701
Practice Address - Fax:423-224-3709
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166194363LF0000X
TN5587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497758551Medicaid
TNP00910852OtherRR MEDICARE
TN3904543Medicaid
TNP00910852OtherRR MEDICARE
VAVVH327AMedicare PIN
TN3904543Medicaid
TN103I509596Medicare PIN
TN3709285Medicare UPIN