Healthcare Provider Details

I. General information

NPI: 1346249224
Provider Name (Legal Business Name): CHRISTOPHER MCCLOUD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 29TH AVE N STE 202
NASHVILLE TN
37203-1401
US

IV. Provider business mailing address

110 29TH AVE N STE 202
NASHVILLE TN
37203-1401
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4304
  • Fax: 615-327-7940
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-081848
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number83988
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: