Basic Information
| Provider Information | |||||||||
| NPI: | 1538101209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRYE | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 CLINCH AVENUE | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TENNESSEE | ||||||||
| PostalCode: | 37916 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 8655412835 | ||||||||
| FaxNumber: | 8655411003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655412835 | ||||||||
| FaxNumber: | 8655411003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN74483 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3342873 | 05 | TN | MEDICAID |