Provider Demographics
NPI:1366984841
Name:PULLEY, KRYSTAL LYNN (RN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:LYNN
Last Name:PULLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:LYNN
Other - Last Name:RYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 66
Mailing Address - Street 2:121 MEADOW LANE
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058
Mailing Address - Country:US
Mailing Address - Phone:931-627-1307
Mailing Address - Fax:
Practice Address - Street 1:330 PAGEANT LANE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-627-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN156503163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health