Healthcare Provider Details

I. General information

NPI: 1558523522
Provider Name (Legal Business Name): KRISTEN MARIE GRANBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MORRISON SPRINGS RD
CHATTANOOGA TN
37415-3401
US

IV. Provider business mailing address

601 MORRISON SPRINGS RD
CHATTANOOGA TN
37415-3401
US

V. Phone/Fax

Practice location:
  • Phone: 615-591-6410
  • Fax: 615-591-6425
Mailing address:
  • Phone: 615-591-6410
  • Fax: 615-591-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1249
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003671
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1249
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: