Individual
SARA ASHLEY MCCRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
776 2ND ST E, ESTILL, SC 29918-4926
(803) 625-2548
(803) 625-2801
Mailing address
PO BOX 357, RIDGELAND, SC 29936-2605
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21497
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21497
STATE LICENSE
SC
Enumeration date
12/13/2017
Last updated
12/13/2017
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