MEDICARE: CRYSTAL MCKINLEY RN, FNP

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	0000027752	TN
2	363LF0000X	Family Nurse Practitioner	026072	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000027752	OTHER	TN	TN BOARD OF NURSING
2	APRN.CNP.026072	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1295371110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MCKINLEY RN, FNP

Provider Business Mailing Address
First Line	:	265 FLETCHERS WAY
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-3646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 FLETCHERS WAY
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-3646
Country	:	US
Telephone Number	:	614-260-0942
Fax Number	:

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

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	04/13/2026

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