Provider Demographics
NPI:1457050916
Name:MCCRACKEN, CAROL ANN (QBHP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:MCCLUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72525-0176
Mailing Address - Country:US
Mailing Address - Phone:870-856-3337
Mailing Address - Fax:870-856-3334
Practice Address - Street 1:2012 HIGHWAY 62 412
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:AR
Practice Address - Zip Code:72542-9477
Practice Address - Country:US
Practice Address - Phone:870-856-3337
Practice Address - Fax:870-856-3334
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator