Healthcare Provider Details

I. General information

NPI: 1962362996
Provider Name (Legal Business Name): VONITA CROSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GREENWOOD AVE
CLARKSVILLE TN
37040-4068
US

IV. Provider business mailing address

812 GREENWOOD AVE
CLARKSVILLE TN
37040-4068
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number188929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: