Provider Demographics
NPI:1316475239
Name:CRAIGHEAD, KATE REBEKAH (FNP-C)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:REBEKAH
Last Name:CRAIGHEAD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:101 CANDLEWOOD CT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2654
Practice Address - Country:US
Practice Address - Phone:434-363-4190
Practice Address - Fax:434-363-4191
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0000000000000000363LF0000X
VA0024175124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily