Provider Demographics
NPI:1255838769
Name:HADORN, CHRISTAL DAWN (APN)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:DAWN
Last Name:HADORN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 NEW HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-5148
Mailing Address - Country:US
Mailing Address - Phone:423-442-3993
Mailing Address - Fax:423-442-9468
Practice Address - Street 1:3469 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-5148
Practice Address - Country:US
Practice Address - Phone:423-442-3993
Practice Address - Fax:423-442-9468
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily