MARY CRADDOCK - NPI 1194436790 - Licensed Practical Nurse in Tyler, TX

Q: What is Mary Craddock's NPI number?

The NPI number for Mary Craddock is 1194436790. It was assigned to this individual provider in the NPPES registry on December 6, 2022.

Q: What is Mary Craddock's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Craddock was last updated on December 6, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Mary Craddock NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY CRADDOCK (NPI 1194436790) is an individual licensed practical nurse in Tyler, Texas, licensed in Texas (165013) and active in the NPI registry since December 2022.

NPPES Registry Identity

NPI1194436790

Entity TypeIndividualFemale

Primary Taxonomy164W00000X

Provider Legal NameMARY CRADDOCK

Location Address9846 HWY 31 ETyler, TX 75705-2329

Mailing Address9846 Hwy 31 ETyler, TX 75705-2329 · (903) 525-3995 · Fax (903) 525-3858

Phone(903) 525-3995

Fax(903) 525-3858

Sole ProprietorNo

Enumeration DateDecember 6, 2022

NPPES CertifiedDecember 6, 2022

✔ NPI 1194436790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers

Taxonomy Code164W00000X

License✔ Licensed in TX · 165013

Definition

A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

9846 HWY 31 E, Tyler, TX 75705

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