Provider Demographics
NPI:1811001373
Name:DOTY, CRISTIN COOK (NPC)
Entity Type:Individual
Prefix:MRS
First Name:CRISTIN
Middle Name:COOK
Last Name:DOTY
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2103
Mailing Address - Country:US
Mailing Address - Phone:615-477-3636
Mailing Address - Fax:
Practice Address - Street 1:975 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-5508
Practice Address - Country:US
Practice Address - Phone:423-778-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN148373163W00000X
TNAPN11681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q62556Medicare UPIN
TN3642421Medicare ID - Type Unspecified