Provider Demographics
NPI:1043784978
Name:CRENSHAW, MARTHA STONE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:STONE
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:GAYLE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4053
Mailing Address - Country:US
Mailing Address - Phone:828-652-6701
Mailing Address - Fax:
Practice Address - Street 1:1264 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3190
Practice Address - Country:US
Practice Address - Phone:828-652-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant