Provider Demographics
NPI:1558350520
Name:HAZLEWOOD, KRISTI GAYE (RN, MSN, CPNP,CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:GAYE
Last Name:HAZLEWOOD
Suffix:
Gender:F
Credentials:RN, MSN, CPNP,CFNP
Other - Prefix:
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Mailing Address - Street 1:404 DORAN RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5521
Mailing Address - Country:US
Mailing Address - Phone:731-686-3201
Mailing Address - Fax:731-686-7979
Practice Address - Street 1:1100 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-5544
Practice Address - Country:US
Practice Address - Phone:731-686-3201
Practice Address - Fax:731-686-7979
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011686363LP0200X
TNAPN11686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics