1477981868 NPI number — KAYLA ELAINE CRYE NP

Table of content: KARISSA E CARSTENSEN M.D. (NPI 1538401948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477981868 NPI number — KAYLA ELAINE CRYE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRYE
Provider First Name:
KAYLA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TULLOCH
Provider Other First Name:
KAYLA
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477981868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37901-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-541-8895
Provider Business Mailing Address Fax Number:
865-633-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11616 CHAPMAN HIGHWAY
Provider Second Line Business Practice Location Address:
EAST TN CHILDREN'S HOSPITAL SEYMOUR PEDIATRICS
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37865-3665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-579-7320
Provider Business Practice Location Address Fax Number:
865-406-8173
Provider Enumeration Date:
10/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  22775 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q029608 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".