Provider Demographics
NPI:1568894541
Name:MCINDOO, CRYSTAL CONSTANCE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CONSTANCE
Last Name:MCINDOO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:CONSTANCE
Other - Last Name:LOZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:7714 CONNER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3559
Practice Address - Country:US
Practice Address - Phone:865-947-6220
Practice Address - Fax:865-512-1069
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program