Provider Demographics
NPI:1669799169
Name:COLLINS, KRYSTAL ANN (APRN, BC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 BAUM DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7360
Mailing Address - Country:US
Mailing Address - Phone:865-584-5727
Mailing Address - Fax:865-450-9904
Practice Address - Street 1:801 N WEISGARBER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2706
Practice Address - Country:US
Practice Address - Phone:865-584-8588
Practice Address - Fax:865-584-3364
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN14668363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I505592Medicare PIN