Provider Demographics
NPI:1447503842
Name:MATTHEWS, CHARLENE CROWDER (FNP)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:CROWDER
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W HIGHWAY 25 70
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-9023
Mailing Address - Country:US
Mailing Address - Phone:423-720-9111
Mailing Address - Fax:423-209-9099
Practice Address - Street 1:157 HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-8157
Practice Address - Country:US
Practice Address - Phone:423-720-9111
Practice Address - Fax:423-301-5756
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16835207QA0505X, 364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038489Medicaid