Individual provider · NPI-1
Angie Craddieth
Technician, Personal Care Attendant · Columbus, MS
NPI number1063138931
StatusActive
Last updated in NPPESNov 13, 2024
Details
- NPI
- 1063138931
- Entity type
- Individual (NPI-1)
- Name
- Angie Craddieth
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 12, 2022
- Certification date
- Nov 13, 2024
- Last updated
- Nov 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747P1801X | Technician, Personal Care Attendant | – | MS | Yes |
| 253Z00000X | In Home Supportive Care | – | – |
Practice location
2240 Military Rd Ste 3Columbus, MS 39705-2456
Phone 662-364-1058
Mailing address
2240 Military Rd Ste 3Columbus, MS 39705-2456
Phone 662-798-0757 · Fax 662-570-1450
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