1023452174 NPI number — KATHERINE A MCCRADY PA-C

Table of content: KATHERINE A MCCRADY PA-C (NPI 1023452174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023452174 NPI number — KATHERINE A MCCRADY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCRADY
Provider First Name:
KATHERINE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023452174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4261 STOCKTON DRIVE SUITE LL100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-975-7456
Provider Business Mailing Address Fax Number:
501-978-1822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 BAPTIST HEALTH DR STE 860
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-975-7455
Provider Business Practice Location Address Fax Number:
501-975-3631
Provider Enumeration Date:
04/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA-508 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 197624795 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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