Healthcare Provider Details

I. General information

NPI: 1972654374
Provider Name (Legal Business Name): GWENDOLYN EMMA DUSO CRENSHAW APN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6473 KINGSTON PIKE
KNOXVILLE TN
75320
US

IV. Provider business mailing address

PO BOX 207830
DALLAS TX
75320-7830
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-8831
  • Fax: 865-588-8841
Mailing address:
  • Phone: 888-412-2649
  • Fax: 405-792-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7802
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: