Provider Demographics
NPI:1922874064
Name:CROWE, MISTY (LPN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAYTONA PL APT 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3091
Mailing Address - Country:US
Mailing Address - Phone:423-268-7709
Mailing Address - Fax:
Practice Address - Street 1:100 DAYTONA PL APT 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3091
Practice Address - Country:US
Practice Address - Phone:423-268-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000050090164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse