Individual
GARY MCCRACKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 SUNSET DR, LAWRENCEBURG, KY 40342-1462
(502) 680-5066
Mailing address
403 SUNSET DR, LAWRENCEBURG, KY 40342-1462
(502) 680-5066
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
08/30/2015
Last updated
11/06/2015
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