Provider Demographics
NPI:1821536574
Name:COLE, CRAIG (KCSA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COLE
Suffix:
Gender:
Credentials:KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-0319
Mailing Address - Country:US
Mailing Address - Phone:901-289-5243
Mailing Address - Fax:
Practice Address - Street 1:4483 KESTREL CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4492
Practice Address - Country:US
Practice Address - Phone:901-289-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA301246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant