Provider Demographics
NPI:1336782747
Name:CRADDOCK, KERRI LYNN (APRN, CNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:APRN, CNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 LARIMER PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9012
Mailing Address - Country:US
Mailing Address - Phone:970-624-2834
Mailing Address - Fax:970-624-2835
Practice Address - Street 1:4846 LARIMER PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9012
Practice Address - Country:US
Practice Address - Phone:970-624-2834
Practice Address - Fax:970-624-2835
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1674643163W00000X
COAPN.0996569-NP363L00000X, 363LF0000X
NM58099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner