Provider Demographics
NPI:1326453622
Name:CRAIG, VICKY (APRN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4113
Mailing Address - Country:US
Mailing Address - Phone:843-951-0053
Mailing Address - Fax:843-951-0054
Practice Address - Street 1:107 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4113
Practice Address - Country:US
Practice Address - Phone:843-951-0053
Practice Address - Fax:843-951-0054
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2025-08-11
Deactivation Date:2025-06-20
Deactivation Code:
Reactivation Date:2025-08-05
Provider Licenses
StateLicense IDTaxonomies
SC103438363L00000X
SC18903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2873Medicaid
SCF0614356OtherAANPCP