Provider Demographics
NPI:1790543247
Name:CRAYCRAFT, HOLLY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CRAYCRAFT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:125 FOXGLOVE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 FOXGLOVE DR STE B
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9735
Practice Address - Country:US
Practice Address - Phone:859-520-9292
Practice Address - Fax:859-520-9004
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4016703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100965230Medicaid