Provider Demographics
NPI:1679895296
Name:CRADDOCK, ALISA ROCHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ROCHELLE
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-1830
Mailing Address - Country:US
Mailing Address - Phone:910-385-7807
Mailing Address - Fax:910-293-7425
Practice Address - Street 1:107 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-1830
Practice Address - Country:US
Practice Address - Phone:910-590-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC178364163W00000X
NCF02241056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse