Provider Demographics
NPI:1245883602
Name:CRALL, DANIEL ALLEN SR (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALLEN
Last Name:CRALL
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7130
Mailing Address - Country:US
Mailing Address - Phone:757-615-7022
Mailing Address - Fax:
Practice Address - Street 1:11611 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7130
Practice Address - Country:US
Practice Address - Phone:901-842-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09235363A00000X
TN4453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant