Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1-092412 | AL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R863289 | MS |
NPI | 1003087289 |
---|---|
Provider Name | Mr. Eric Ashley Mccraney |
First Address | Lucedale, MS 39452-1007 |
Second Address | Leakesville, MS 39451-9105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 27/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011846 | MEDICARE GROUP NUMBER (01) | AL |
05523153 | (05) | MS |
1063439065 | NPI SITE GROUP PAYEE NUMBER (01) | AL |
630000013 | (05) | AL |