Healthcare Provider Details

I. General information

NPI: 1134760630
Provider Name (Legal Business Name): ALYSE HOLMES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSE FLACK

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 RIVERFRONT PKWY # 100
CHATTANOOGA TN
37402-2108
US

IV. Provider business mailing address

3004 EASTON AVE
CHATTANOOGA TN
37415-5857
US

V. Phone/Fax

Practice location:
  • Phone: 423-206-9000
  • Fax:
Mailing address:
  • Phone: 423-661-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26565
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: