Provider Demographics
NPI:1457808792
Name:CRISP, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-4756
Mailing Address - Country:US
Mailing Address - Phone:828-775-1475
Mailing Address - Fax:
Practice Address - Street 1:2160 MARTIN RD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-4756
Practice Address - Country:US
Practice Address - Phone:828-775-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL196154246QC1000X, 246QH0000X, 246QI0000X, 246QM0900X
196154246QB0000X, 246RM2200X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking
No246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematology
No246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy