Healthcare Provider Details

I. General information

NPI: 1831728559
Provider Name (Legal Business Name): KRISTEN SALYARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN DICKERSON

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S ILLINOIS AVE
OAK RIDGE TN
37830-7510
US

IV. Provider business mailing address

441 S ILLINOIS AVE
OAK RIDGE TN
37830-7510
US

V. Phone/Fax

Practice location:
  • Phone: 865-685-0767
  • Fax:
Mailing address:
  • Phone: 865-685-0767
  • Fax: 865-685-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95014208
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: