Healthcare Provider Details

I. General information

NPI: 1538101209
Provider Name (Legal Business Name): CAROL D CRYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 W CLINCH AVE
KNOXVILLE TN
37916-2434
US

IV. Provider business mailing address

1819 CLINCH AVENUE SUITE 214
KNOXVILLE TENNESSEE
37916
UM

V. Phone/Fax

Practice location:
  • Phone: 865-541-2835
  • Fax: 865-541-1003
Mailing address:
  • Phone: 865-541-2835
  • Fax: 865-541-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN74483
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: