Basic Information
| Provider Information | |||||||||
| NPI: | 1184353096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEGIONS-HOLDEN | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | AGACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27A MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315243310 | ||||||||
| FaxNumber: | 7314244109 | ||||||||
| Practice Location | |||||||||
| Address1: | 27A MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315243310 | ||||||||
| FaxNumber: | 7314244109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 83 | TN | N | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363LA2100X | 31707 | TN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.