Provider Demographics
NPI:1104825157
Name:CRAGO, APRIL (PA)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:CRAGO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:HIGHMORE
Mailing Address - State:SD
Mailing Address - Zip Code:57345-0259
Mailing Address - Country:US
Mailing Address - Phone:605-852-2238
Mailing Address - Fax:
Practice Address - Street 1:200 COMMERCIAL AVE SE
Practice Address - Street 2:BOX 259
Practice Address - City:HIGHMORE
Practice Address - State:SD
Practice Address - Zip Code:57345
Practice Address - Country:US
Practice Address - Phone:605-852-2238
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0545363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD431815OtherBLUE CROSS BLUE SHIELD
SDQ15438Medicare UPIN
SDS41882Medicare ID - Type Unspecified