Provider Demographics
NPI:1861816704
Name:MCCROSKEY, LAUREN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:MCCROSKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 FENWAY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4567
Mailing Address - Country:US
Mailing Address - Phone:865-973-2920
Mailing Address - Fax:
Practice Address - Street 1:5509 FENWAY LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4567
Practice Address - Country:US
Practice Address - Phone:865-973-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000171180163W00000X
TNAPN0000018280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000171180OtherRN LICENSE
TNAPN0000018280OtherFNP LICENSE
TN2013017606OtherANCC