Healthcare Provider Details

I. General information

NPI: 1548173735
Provider Name (Legal Business Name): JACOB CRABTREE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 JOULE ST
ALCOA TN
37701-2422
US

IV. Provider business mailing address

604 W 10TH AVE
LENOIR CITY TN
37771-1521
US

V. Phone/Fax

Practice location:
  • Phone: 865-268-1344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43137
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: