Kyoung Craddock

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN60221376 Issued in WA

Practice address

5722 65TH St NE
Marysville, WA 98270

Phone

(253) 590-6817

NPI assigned

Jun 2, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• K&J Nurse Delegation LLC

  • Registered Nurse
  • Marysville, WA
  • NPI 1659820710
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1497103162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5722 65TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "98270",
            "telephone_number": "253-590-6817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5722 65TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "98270",
            "telephone_number": "253-590-6817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRADDOCK",
        "first_name": "KYOUNG",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60221376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING SERVICE PROVIDERS, REGISTERED NURSE (NURSE DELEGATION)",
            "identifier": "163W00000X",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Marie Cotroneo, OTR/L
• Bridgette Lena Couevas, LMT
• Courage Afh LLC
• Linda Denise Crabtree, MC, LMHC, CMHS
• Jirapa Craddock
• Nicola Marie Cram, MS, CCC-SLP
• Jamie Lee Crawford, ARNP
• Conner Cress, LMHC, LPCC
• Brittany Noelle Crolley, LMP
• Colleen Cruz, LMT

• Registered Nurse in Marysville, WA
• Providers in Marysville, WA by specialty
• Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.

Verify at the official NPI Registry.