Provider Demographics
NPI:1285411629
Name:CRADDOCK, BRIANA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:MICHELLE
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:MICHELLE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 E CHESTNUT ST # 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-9581
Practice Address - Fax:502-266-2632
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4009356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily