Provider Demographics
NPI:1184355059
Name:BECRAFT, KATHRYN MARIE (CNM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:BECRAFT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 SAINT LEGER DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-4540
Mailing Address - Country:US
Mailing Address - Phone:717-422-4467
Mailing Address - Fax:
Practice Address - Street 1:777 LOWNDES HILL RD BLDG 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2101
Practice Address - Country:US
Practice Address - Phone:800-967-2289
Practice Address - Fax:864-627-9920
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
NC934367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife