Provider Demographics
NPI:1609901677
Name:CRAVEN, KATHLEEN L
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:CRAVEN
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 1:407 S COX ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5716
Mailing Address - Country:US
Mailing Address - Phone:336-625-4456
Mailing Address - Fax:336-625-3933
Practice Address - Street 1:407 S COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5716
Practice Address - Country:US
Practice Address - Phone:336-625-4456
Practice Address - Fax:336-625-3933
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC756156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0176750001Medicare NSC