Provider Demographics
NPI:1184608895
Name:RUCKER, KRISTY LYNN (RN, MSN, FNP,)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:RUCKER
Suffix:
Gender:F
Credentials:RN, MSN, FNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:10215 KINGSTON PIKE STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3492
Practice Address - Country:US
Practice Address - Phone:865-691-0733
Practice Address - Fax:833-908-2087
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA471268OtherRN LICENSE #
CA#9220OtherNP FURNISHING LICENSE #
CAF0816720OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS