Provider Demographics
NPI:1528400595
Name:PARRIS, CRAIG JEFFREY (FNP)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JEFFREY
Last Name:PARRIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:614-544-6210
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-566-4924
Practice Address - Fax:614-566-6636
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14784-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089015Medicaid
OH0089015Medicaid
OHH230450Medicare PIN