Provider Demographics
NPI:1871372870
Name:WELCH, CRYSTAL LYNNE (MSN, RN, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSN, RN, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6988
Mailing Address - Country:US
Mailing Address - Phone:931-248-1397
Mailing Address - Fax:
Practice Address - Street 1:851 S WILLOW AVE STE 108
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4223
Practice Address - Country:US
Practice Address - Phone:931-284-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98700163W00000X
TN2555133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse