MEDICARE: MR. LARRY GENE CRISP CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN 7946	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275693921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY GENE CRISP CFNP

Provider Business Mailing Address
First Line	:	139 COUNTY ROAD 100
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-5005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16850 STATE HIGHWAY 58 S STE A
Second Line	:
City	:	DECATUR
State	:	TN
Zip	:	37322-5259
Country	:	US
Telephone Number	:	423-334-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/23/2024

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