Provider Demographics
NPI:1538777081
Name:MCCRAVEY, ATLANTA GAYLE RUSSELL (FNP-BC)
Entity type:Individual
Prefix:
First Name:ATLANTA
Middle Name:GAYLE RUSSELL
Last Name:MCCRAVEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ATLANTA
Other - Middle Name:GAYLE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1223 BUFORD CT
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-3044
Mailing Address - Country:US
Mailing Address - Phone:423-200-7505
Mailing Address - Fax:
Practice Address - Street 1:2166 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3035
Practice Address - Country:US
Practice Address - Phone:865-273-9024
Practice Address - Fax:865-273-9025
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner