Provider Demographics
NPI:1700146909
Name:CROWE, JESSICA HUTCHISON (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HUTCHISON
Last Name:CROWE
Suffix:
Gender:F
Credentials:MD
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 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2130 N CHARLES SEIVERS BOULEVARD
Practice Address - Street 2:SUITE 4
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6705
Practice Address - Country:US
Practice Address - Phone:865-457-4044
Practice Address - Fax:866-699-4833
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52628208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534545Medicaid