Provider Demographics
NPI:1568060119
Name:CLINGENPEEL, KRISTEN GRIZZELL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GRIZZELL
Last Name:CLINGENPEEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:TAYLOR
Other - Last Name:GRIZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 BRANNER AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2210
Mailing Address - Country:US
Mailing Address - Phone:865-471-3350
Mailing Address - Fax:865-471-4411
Practice Address - Street 1:2130 BRANNER AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2210
Practice Address - Country:US
Practice Address - Phone:865-471-3350
Practice Address - Fax:865-471-4411
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN239244163W00000X
TN28335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse