Provider Demographics
NPI:1720457609
Name:CRAIG, TRACI (PNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-2091
Mailing Address - Country:US
Mailing Address - Phone:903-280-7716
Mailing Address - Fax:
Practice Address - Street 1:345 STONE AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9309
Practice Address - Country:US
Practice Address - Phone:903-280-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX763673363LP0200X
TXAP129199363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720457609Medicaid
TX1720457609Medicaid