Provider Demographics
NPI:1275598849
Name:CRESSEL, SUE A (FNP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:CRESSEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:2534 MENDOTA RD
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:VA
Practice Address - Zip Code:24270-2018
Practice Address - Country:US
Practice Address - Phone:276-645-6710
Practice Address - Fax:276-645-6712
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5784363L00000X
VA0024062526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4349902Medicaid
S53123Medicare UPIN
TN4349902Medicaid