Provider Demographics
NPI:1548434038
Name:KEY, CHRISLA TIDWELL (DNP, FNP, NP-C)
Entity type:Individual
Prefix:
First Name:CHRISLA
Middle Name:TIDWELL
Last Name:KEY
Suffix:
Gender:F
Credentials:DNP, FNP, NP-C
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Other - Last Name:
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Mailing Address - Street 1:51 N DUNLAP ST STE 250
Mailing Address - Street 2:UT LE BONHEUR PEDIATRIC SPECIALIST- UROLOGY
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4625
Mailing Address - Country:US
Mailing Address - Phone:901-287-4030
Mailing Address - Fax:
Practice Address - Street 1:51 N DUNLAP ST STE 100
Practice Address - Street 2:UT LE BONHEUR PEDIATRIC SPECIALISTS- UROLOGY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-287-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily