Provider Demographics
NPI:1518570225
Name:CRADDOCK, TONI LYN
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYN
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HEWETT TOWN CIR
Mailing Address - Street 2:
Mailing Address - City:HEWETT
Mailing Address - State:WV
Mailing Address - Zip Code:25108-7400
Mailing Address - Country:US
Mailing Address - Phone:304-369-6305
Mailing Address - Fax:
Practice Address - Street 1:113 HEWETT TOWN CIR
Practice Address - Street 2:
Practice Address - City:HEWETT
Practice Address - State:WV
Practice Address - Zip Code:25108-7400
Practice Address - Country:US
Practice Address - Phone:304-369-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant