Healthcare Provider Details

I. General information

NPI: 1942171244
Provider Name (Legal Business Name): CHRISSY MOSES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 KNOB CREEK RD STE 720
JOHNSON CITY TN
37604-2977
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-6112
  • Fax: 423-434-0278
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: