Provider Demographics
NPI:1023485190
Name:HOUGHTON, KRISTY RENEE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:RENEE
Last Name:HOUGHTON
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-538-5116
Mailing Address - Fax:423-538-3861
Practice Address - Street 1:229 HIGHWAY 19 E
Practice Address - Street 2:
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618-1865
Practice Address - Country:US
Practice Address - Phone:423-538-5116
Practice Address - Fax:423-538-3861
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178048363LF0000X
TN18887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily