Provider Demographics
NPI:1194123364
Name:KRAKEEL, ALLISON M (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:KRAKEEL
Suffix:
Gender:F
Credentials:APRN
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 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:459 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3924
Practice Address - Country:US
Practice Address - Phone:843-899-3870
Practice Address - Fax:843-899-3877
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19136363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC5269I818OtherMEDICARE PIN
SCNP3080Medicaid
SCSC52696834Medicare PIN
SCSC52697555Medicare PIN
SCSC52697006Medicare PIN
SCSC52697498Medicare PIN
SCSC52697126Medicare PIN
SCSC52698798Medicare PIN
SCSC52697819Medicare PIN
SCSC52695277Medicare PIN
SCSC52695282Medicare PIN
SCSC52696882Medicare PIN
SCSC52695281Medicare PIN
SCSC52697499Medicare PIN
SCSC52697522Medicare PIN