Provider Demographics
NPI:1942969084
Name:CRADDOCK, MARGARET LYNN (CM/RN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LYNN
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:CM/RN
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 697
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0697
Mailing Address - Country:US
Mailing Address - Phone:304-373-1456
Mailing Address - Fax:304-373-1330
Practice Address - Street 1:202 MAIN ST W
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1414
Practice Address - Country:US
Practice Address - Phone:304-373-1456
Practice Address - Fax:304-373-1330
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50984171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator