Healthcare Provider Details

I. General information

NPI: 1770264830
Provider Name (Legal Business Name): CRYSTAL JYRKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 JACKSBORO PIKE
LA FOLLETTE TN
37766-3003
US

IV. Provider business mailing address

2145 JACKSBORO PIKE
LA FOLLETTE TN
37766-3003
US

V. Phone/Fax

Practice location:
  • Phone: 423-907-1700
  • Fax: 423-907-1711
Mailing address:
  • Phone: 423-907-1700
  • Fax: 423-907-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number34051
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: