Provider Demographics
NPI:1306054283
Name:CRAFT, BRYAN K (HH AIDE)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:CRAFT
Suffix:
Gender:M
Credentials:HH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1702
Mailing Address - Country:US
Mailing Address - Phone:740-464-5754
Mailing Address - Fax:
Practice Address - Street 1:10262 GALLIA PIKE RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8435
Practice Address - Country:US
Practice Address - Phone:740-574-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2716065374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH733050929501Medicaid