Provider Demographics
NPI:1508258328
Name:COLLINS, CRISSY
Entity Type:Individual
Prefix:
First Name:CRISSY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISSY
Other - Middle Name:D
Other - Last Name:BAGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 270
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2662
Mailing Address - Country:US
Mailing Address - Phone:423-602-9545
Mailing Address - Fax:423-602-9546
Practice Address - Street 1:7405 SHALLOWFORD RD STE 270
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2662
Practice Address - Country:US
Practice Address - Phone:423-602-9545
Practice Address - Fax:423-602-9546
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN163375163W00000X
TN19747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse