Provider Demographics
NPI:1871909507
Name:MCCRAY, MISTY SUZANNE (FNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:SUZANNE
Last Name:MCCRAY
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 1:988 OAK RIDGE TPKE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6919
Mailing Address - Country:US
Mailing Address - Phone:865-483-4366
Mailing Address - Fax:865-483-5957
Practice Address - Street 1:988 OAK RIDGE TPKE STE 200
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-483-4366
Practice Address - Fax:865-483-5957
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006990Medicaid