RICHARD W CRADDOCK (NPI# 1467768804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467768804 |
| Entity Type | Individual |
| Full Name | RICHARD W CRADDOCK |
| Credential | PA-C |
| Practice Address |
500 Poplar St South Charleston WV 25309-1474 |
| Practice Telephone | 3043423891 |
| Practice Fax Number | 3043425307 |
| Mailing Telephone | 3043423891 |
| Mailing Fax Number | 3043425307 |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2012-11-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 00292 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536875 | Richard Andrew Craddock | Massage Therapist | 2745 Wild Pines Ln Apt 523, Naples, FL 34112-4753 | 2020-10-23 |
| 1003805854 | Richard G Craddock | Internal Medicine | 1201 Se Indian St, Stuart, FL 34997-5688 | 2005-10-14 |
| Street Address |
500 POPLAR ST |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1474 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447257787 | Emad A Kowatli | Internal Medicine | 500 Poplar St, Suite 204, South Charleston, WV 25309-1474 | 2005-07-01 |
| 1083013353 | Lisa Marie Mcclure | Nurse Practitioner | 500 Poplar St, Suite 202, South Charleston, WV 25309-1474 | 2014-08-22 |
| 1881009181 | Charleston Gynecology Pllc | Specialist | 500 Poplar St, Suite 203, South Charleston, WV 25309-1474 | 2014-06-25 |
| 1720262546 | Osterman Cotes, M.d. Pllc | Obstetrics & Gynecology | 500 Poplar St, Suite 200, South Charleston, WV 25309-1474 | 2007-12-28 |
| 1497944136 | Neurology & Pain Center Pllc | Psychiatry & Neurology | 500 Poplar St, Suite 201, South Charleston, WV 25309-1474 | 2007-10-18 |
| 1003013681 | Comprehensive Surgical Associates Pllc | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-06-28 |
| 1255537999 | Johnna Michelle Jackson | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-06-21 |
| 1942429790 | Kristen Price Eads | Surgery | 500 Poplar St, Suite 304, South Charleston, WV 25309-1474 | 2007-04-24 |
| 1477623775 | Greta Virginia Guyer | Internal Medicine | 500 Poplar St, Suite 202, South Charleston, WV 25309-1474 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518564012 | Lauren Brianne Peyton | Physician Assistant | 5322 Indiana St Apt 4, South Charleston, WV 25309-1055 | 2020-10-07 |
| 1700297207 | Ricky Mcdaniels | Physician Assistant | 4607 Maccorkle Ave Sw Ste 300, South Charleston, WV 25309-1364 | 2014-05-19 |
| 1013192046 | Carla R. Nutter | Physician Assistant | 4169 Kanawha Avenue Sw, South Charleston, WV 25309 | 2008-01-09 |
| 1952371320 | Kellie Anne Hansel | Physician Assistant | 509 2nd Ave, South Charleston, WV 25303-1310 | 2006-01-26 |
| 1053390450 | Gregory Porter | Physician Assistant | 707 Chestnut St, South Charleston, WV 25309-2003 | 2006-01-13 |
| 1316579949 | Mary Rose Butcher | Physician Assistant | 610 Chestnut St, South Charleston, WV 25309-1251 | 2020-02-11 |
| 1568002509 | Alexa Marie Engel | Physician Assistant | 607 Chestnut St, South Charleston, WV 25309-1205 | 2020-01-07 |
| 1659856383 | Maccorkle Emergency Physicians Pllc | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-09-28 |
| 1548772411 | Kaitlin Christine Scarberry | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2017-10-31 |
| 1104348689 | Aris L Smith | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2017-07-17 |
| Find all providers in SOUTH CHARLESTON | ||||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.