Healthcare Provider Details

I. General information

NPI: 1871700815
Provider Name (Legal Business Name): KRISTI DEANNE DUFFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 W FOREST AVE
JACKSON TN
38301-3902
US

IV. Provider business mailing address

1805 WILLIAMSON CT
BRENTWOOD TN
37027-8164
US

V. Phone/Fax

Practice location:
  • Phone: 731-574-3000
  • Fax:
Mailing address:
  • Phone: 615-331-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTN 0425
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: