Healthcare Provider Details

I. General information

NPI: 1861556110
Provider Name (Legal Business Name): CHRYSTAL LYNN HENSLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OKOLONA DR
ERWIN TN
37650-1387
US

IV. Provider business mailing address

1363 COFFEE RIDGE LOOP
ERWIN TN
37650-6450
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-9103
  • Fax: 423-743-9105
Mailing address:
  • Phone: 423-735-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000116620
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: