Provider Demographics
NPI:1538377692
Name:CRAFT, ANDREA MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:HERMANVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39086-9620
Mailing Address - Country:US
Mailing Address - Phone:601-535-7937
Mailing Address - Fax:601-535-7937
Practice Address - Street 1:6116 SHELBY RD
Practice Address - Street 2:
Practice Address - City:HERMANVILLE
Practice Address - State:MS
Practice Address - Zip Code:39086-9620
Practice Address - Country:US
Practice Address - Phone:601-535-7937
Practice Address - Fax:601-535-7937
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP316647164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770524Medicaid
MSP316647OtherNURSING LICENSE NUMBER