Provider Demographics
NPI:1053603258
Name:MOSES, CRYSTAL G (CPNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:G
Last Name:MOSES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOWN CREEK RD E
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5690
Mailing Address - Country:US
Mailing Address - Phone:865-986-1400
Mailing Address - Fax:865-986-9400
Practice Address - Street 1:125 TOWN CREEK RD E
Practice Address - Street 2:SUITE 2B
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5690
Practice Address - Country:US
Practice Address - Phone:865-986-1400
Practice Address - Fax:865-986-9400
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15813363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics