Provider Demographics
NPI:1679895296
Name:CRADDOCK, ALISA ROCHELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ROCHELLE
Last Name:CRADDOCK
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-0187
Mailing Address - Country:US
Mailing Address - Phone:910-267-2042
Mailing Address - Fax:855-996-9090
Practice Address - Street 1:906 N US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-0410
Practice Address - Country:US
Practice Address - Phone:910-592-1462
Practice Address - Fax:910-808-1040
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC178364163W00000X
NCF02241056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse