Provider Demographics
NPI:1750587309
Name:CRAIG, FARAH GAIL (PNP)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:GAIL
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-4867
Mailing Address - Fax:614-722-4380
Practice Address - Street 1:1171 W TIPTON ST STE D
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2794
Practice Address - Country:US
Practice Address - Phone:812-524-8780
Practice Address - Fax:812-524-8746
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP.10034363LP0200X
IN28149810A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28149810AOtherINDIANA LICENSE
OH2829818Medicaid
IN28149810AOtherINDIANA LICENSE