Healthcare Provider Details

I. General information

NPI: 1093137259
Provider Name (Legal Business Name): CATHERINE WATSON CRUTCHFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N PARKWAY
JACKSON TN
38305-3058
US

IV. Provider business mailing address

804 N PARKWAY
JACKSON TN
38305-3058
US

V. Phone/Fax

Practice location:
  • Phone: 731-423-3020
  • Fax: 731-927-8601
Mailing address:
  • Phone: 731-423-3020
  • Fax: 731-927-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0000159415
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: