Provider Demographics
NPI:1982684676
Name:NORTHCRAFT, PATRICK G (NP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:NORTHCRAFT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 AMHERST ST STE F
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-536-0110
Mailing Address - Fax:540-536-0031
Practice Address - Street 1:1870 AMHERST ST STE F
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2841
Practice Address - Country:US
Practice Address - Phone:540-536-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60297363LF0000X
VA0024165477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982684676Medicaid
WV7103226000Medicaid
VAP00657228OtherMEDICARE RR
VAMC10563Medicare PIN
VAP00657228OtherMEDICARE RR