Provider Demographics
NPI:1467025742
Name:CLOUSE, KRISTEN AMBURN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:AMBURN
Last Name:CLOUSE
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 1:606 CALTHORPE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2145
Mailing Address - Country:US
Mailing Address - Phone:865-804-8479
Mailing Address - Fax:
Practice Address - Street 1:10408 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3293
Practice Address - Country:US
Practice Address - Phone:865-692-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN224577163W00000X
TN29560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse