Provider Demographics
NPI:1487476925
Name:SHIELDS, CRYSTAL CROCKETT
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CROCKETT
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8252 MARTIN MILL PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-7542
Mailing Address - Country:US
Mailing Address - Phone:865-712-6615
Mailing Address - Fax:
Practice Address - Street 1:8252 MARTIN MILL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-7542
Practice Address - Country:US
Practice Address - Phone:865-712-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN591396374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula