Provider Demographics
NPI:1639731185
Name:MCCRACKEN, KATHERINE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5703
Mailing Address - Country:US
Mailing Address - Phone:601-918-8367
Mailing Address - Fax:
Practice Address - Street 1:2703 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2328
Practice Address - Country:US
Practice Address - Phone:903-838-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9780T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist