Provider Demographics
NPI:1376099960
Name:PAYNE, CRISTAL DENISE (FNP-BC, AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CRISTAL
Middle Name:DENISE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-BC, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 DESALES AVE.
Mailing Address - Street 2:300 SOUTH
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1161
Mailing Address - Country:US
Mailing Address - Phone:423-495-4947
Mailing Address - Fax:423-495-6155
Practice Address - Street 1:2525 DESALES AVE
Practice Address - Street 2:300 SOUTH
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-495-8300
Practice Address - Fax:423-495-6155
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21286363LA2100X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology