Provider Demographics
NPI:1588147722
Name:CRAGG, YOSHIKA
Entity type:Individual
Prefix:
First Name:YOSHIKA
Middle Name:
Last Name:CRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 S 61ST ST APT 102A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1048
Mailing Address - Country:US
Mailing Address - Phone:214-842-2618
Mailing Address - Fax:
Practice Address - Street 1:2402 S 61ST ST APT 102A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1048
Practice Address - Country:US
Practice Address - Phone:214-842-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331894164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherUNKNOWN