Healthcare Provider Details

I. General information

NPI: 1275942401
Provider Name (Legal Business Name): MYSTIE KAROLE SWINGLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYSTIE KAROLE DERRICK

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GUNBARREL RD STE 302
CHATTANOOGA TN
37421-3291
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-2904
  • Fax: 423-892-5058
Mailing address:
  • Phone: 423-308-0280
  • Fax: 423-308-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18948
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: