Provider Demographics
NPI:1154302164
Name:CREWS, RITA (MHSA, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:CREWS
Suffix:
Gender:F
Credentials:MHSA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRADSHAW HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-4629
Mailing Address - Country:US
Mailing Address - Phone:865-348-5854
Mailing Address - Fax:
Practice Address - Street 1:400 GOODYS LN STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1900
Practice Address - Country:US
Practice Address - Phone:865-288-8320
Practice Address - Fax:865-288-5903
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2349363A00000X
TN3698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5368Medicare PIN