| Doctor Name: | CRYSTAL G MOSES |
| NPI Number: | 1053603258 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 15813 |
| Business Practice Address: | 125 Town Creek Rd E Suite 2b Lenoir City, TN - 377725690 |
| Business Phone Number: | 8659861400 |
| Business Fax Number: | 8659869400 |
| Mailing Address: | 125 Town Creek Rd E, Suite 2b LENOIR CITY |
| State: | TN |
| Postal Code: | 377725690 |
| Phone Number: | 8659861400 |
| Fax Number: | 8659869400 |
| NPI Enumeration Date: | 05/05/2011 |
| NPI Last Update Date: | 05/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 15813 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |