Provider Demographics
NPI:1619924495
Name:CRAIG, KYM (PA)
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PA
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 164
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79702-0164
Mailing Address - Country:US
Mailing Address - Phone:432-704-5661
Mailing Address - Fax:432-704-5660
Practice Address - Street 1:407 KENT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5858
Practice Address - Country:US
Practice Address - Phone:432-704-5661
Practice Address - Fax:432-704-5660
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q33532Medicare UPIN