Walter Carl Credle IV, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10976 Issued in NC

Practice address

400 Shadowline Dr Ste 204
Boone, NC 28607-5022

Phone

(704) 237-4240

Fax

(877) 847-0561

NPI assigned

Oct 13, 2020

Last updated

Feb 23, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1649131798
  NPD (past)

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1598363541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SHADOWLINE DR STE 204",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286075022",
            "telephone_number": "828-202-9765",
            "fax_number": "877-847-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SHADOWLINE DR STE 204",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286075022",
            "telephone_number": "704-237-4240",
            "fax_number": "877-847-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREDLE",
        "first_name": "WALTER",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-13",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond Lynn Coward, PHD LMFT
• Anne Hunter Cox, SLP-CF
• Craig Bridgeman DMD PA
• Margaret Louise Craig, MD
• Jenna Wilson Crawley, LPC, LCAS
• Karen F Criminger, F.N.P.
• Laddie Moore Crisp III, MD
• Shelby Critcher Hagie, OTR/L
• Shauna Critcher, PA-C
• Jeffrey Paul Crittenden, MD

• Physician Assistant in Boone, NC
• Providers in Boone, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; 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.