Healthcare Provider Details

I. General information

NPI: 1871909507
Provider Name (Legal Business Name): MISTY SUZANNE MCCRAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

988 OAK RIDGE TPKE STE 200
OAK RIDGE TN
37830-6919
US

IV. Provider business mailing address

988 OAK RIDGE TPKE STE 200
OAK RIDGE TN
37830-6919
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-4366
  • Fax: 865-483-5957
Mailing address:
  • Phone: 865-483-4366
  • Fax: 865-483-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: