Provider Demographics
NPI:1417137860
Name:TOLBERT, KRISTY LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:MAGURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W 4TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2474
Mailing Address - Country:US
Mailing Address - Phone:931-528-7877
Mailing Address - Fax:931-526-3261
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2448
Practice Address - Country:US
Practice Address - Phone:931-528-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN131455367500000X
TN8199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4168900OtherBCBST
TN33497021Medicaid
TN4168900OtherBCBST
P96892Medicare UPIN