Provider Demographics
NPI:1649767104
Name:CRAIG, KELLY DENISE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:CRAIG
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 1:1515 OGDEN ST NW APT 123
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1246
Mailing Address - Country:US
Mailing Address - Phone:202-749-6443
Mailing Address - Fax:
Practice Address - Street 1:1515 OGDEN ST NW APT 123
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1246
Practice Address - Country:US
Practice Address - Phone:202-749-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant