Healthcare Provider Details

I. General information

NPI: 1457006215
Provider Name (Legal Business Name): CHARITY KRISTA ZOODSMA MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 4TH ST STE 201
COOKEVILLE TN
38501-2413
US

IV. Provider business mailing address

140 W 7TH ST
COOKEVILLE TN
38501-1726
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-4269
  • Fax:
Mailing address:
  • Phone: 931-783-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number31155
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: