Provider Demographics
NPI:1538406491
Name:CRAGLE, LOREN ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:ELAINE
Last Name:CRAGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THORNCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6578
Mailing Address - Country:US
Mailing Address - Phone:570-704-8151
Mailing Address - Fax:
Practice Address - Street 1:420 THE PKWY STE N
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5205
Practice Address - Country:US
Practice Address - Phone:864-655-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003693363A00000X
SC2589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant