Provider Demographics
NPI:1922297217
Name:CRADDOCK, CAROLINE SUE (BSN, MSN, ARNP-CANP)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:SUE
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:BSN, MSN, ARNP-CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:STAGECOACH
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8408
Mailing Address - Country:US
Mailing Address - Phone:832-654-3797
Mailing Address - Fax:
Practice Address - Street 1:14707 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:STAGECOACH
Practice Address - State:TX
Practice Address - Zip Code:77355-8408
Practice Address - Country:US
Practice Address - Phone:832-654-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner