Healthcare Provider Details

I. General information

NPI: 1629010392
Provider Name (Legal Business Name): GARY CROTTY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E WEISGARBER RD STE 200
KNOXVILLE TN
37909-2675
US

IV. Provider business mailing address

PO BOX 635
POWELL TN
37849-0635
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-4747
  • Fax: 865-212-3718
Mailing address:
  • Phone: 865-938-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6215
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: