Healthcare Provider Details

I. General information

NPI: 1508258328
Provider Name (Legal Business Name): CRISSY COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISSY D BAGGETT NP

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 LEE HWY STE 103
OOLTEWAH TN
37363-4440
US

IV. Provider business mailing address

9219 LEE HWY STE 103
OOLTEWAH TN
37363-4440
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-6483
  • Fax:
Mailing address:
  • Phone: 423-648-6483
  • Fax: 423-648-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number19747
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19747
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163375
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: