Provider Demographics
NPI:1144634486
Name:HARRIS, CRYSTAL LYNNA (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNNA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LYNNA
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:220 ATHENS WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1351
Mailing Address - Country:US
Mailing Address - Phone:615-320-1155
Mailing Address - Fax:615-320-1177
Practice Address - Street 1:8000 CENTERVIEW PKWY STE 201
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4256
Practice Address - Country:US
Practice Address - Phone:615-320-1155
Practice Address - Fax:615-320-1177
Is Sole Proprietor?:No
Enumeration Date:2014-06-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18380363LA2200X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012836Medicaid
MS06587063Medicaid