Active NPI
Jessica Craddock
- Physical Therapy Assistant
- Overland Park, KS
National Provider Identifier
1255874277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 14-02950
- Practice address
- 7600 Antioch Rd
Overland Park, KS 66204-2622 - Phone
- (913) 383-2001
- NPI assigned
- Nov 22, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 14-02950 | KS | Primary |
Addresses
Primary practice location
7600 Antioch Rd
Overland Park, KS 66204-2622
Mailing address
501 SE Asheville Dr
Lees Summit, MO 64063-1066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14-02950 | KS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479772800000",
"number": "1255874277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 SE ASHEVILLE DR",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640631066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 ANTIOCH RD",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662042622",
"telephone_number": "913-383-2001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRADDOCK",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-22",
"last_updated": "2016-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KS",
"license": "14-02950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.