Healthcare Provider Details

I. General information

NPI: 1134085202
Provider Name (Legal Business Name): CRYSTALLE GRIFFITH ACAGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

321 HATFIELD CIR
ONEIDA TN
37841-3541
US

V. Phone/Fax

Practice location:
  • Phone: 423-286-5390
  • Fax: 423-286-5309
Mailing address:
  • Phone: 423-701-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number40638
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: