Provider Demographics
NPI:1174548630
Name:MCCRACKIN, CARRIE A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:MCCRACKIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:BROTHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0389
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-8120
Practice Address - Fax:256-265-8969
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-063681367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533367OtherBCBSAL #
AL051533367Medicaid
AL051533367Medicaid
AL051533367Medicare PIN