CROSSROADS CLINIC PLLC (NPI# 1043662687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043662687 |
| Entity Type | Organization |
| Organization Name | CROSSROADS CLINIC PLLC |
| Practice Address |
1667 Ooltewah Ringgold Rd Suite 111 Ooltewah TN 37363-9830 |
| Practice Telephone | 4238254881 |
| Practice Fax Number | 4238254882 |
| Mailing Telephone | 4238254881 |
| Mailing Fax Number | 4238254882 |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |
| Authorized Official Name | MRS. SUSAN VERGOT (OWNER) |
| Authorized Official Telephone | 4239020681 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1667 OOLTEWAH RINGGOLD RD SUITE 111 |
| City | OOLTEWAH |
| State | TN |
| Zip Code | 37363-9830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053529206 | Margaret Kopp Barrie | Pharmacist | 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9433 | 2007-05-20 |
| 1295102986 | K Va T Food Stores, Inc. | Durable Medical Equipment & Medical Supplies | 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9830 | 2015-08-28 |
| 1750773016 | Brandon Weldy | Pharmacist | 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9830 | 2015-02-24 |
| 1417230129 | Main Street Medical, Pllc | Specialist | 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9830 | 2011-09-20 |
| 1922256486 | Daniel James Platt | Pharmacist | 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9433 | 2008-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487203196 | University Health Center | Clinic/Center | 4687 University Drive, Ooltewah, TN 37363 | 2019-09-05 |
| 1508426560 | Alexandra Scott | Dentist | 8985 Old Lee Hwy, Suite 103, Ooltewah, TN 37363 | 2019-06-20 |
| 1093286304 | Wright Pediatric Dentistry | Dentist | 8202 Apison Pike, Ooltewah, TN 37363 | 2018-12-13 |
| 1770052888 | Bio-medical Applications of Tennessee, Inc. | Clinic/Center | 6085 Arbury Way, Ooltewah, TN 37363 | 2018-11-19 |
| 1679055008 | Rebecca Brown | Nurse Practitioner | 9801 Robinson Farm Rd, Ooltewah, TN 37363 | 2018-09-01 |
| 1750877833 | Amanda Kirkpatrick | Dietitian, Registered | 6103 Hunter Crest Drive, Ooltewah, TN 37363 | 2018-07-02 |
| 1447759493 | Abigale Daniels | Specialist/Technologist | 6154 Wardwell Drive, Ooltewah, TN 37363 | 2018-02-06 |
| 1538671748 | Ryan Volking | Physician Assistant | 7564 Passport Dr, Ooltewah, TN 37363 | 2017-10-27 |
| 1255882270 | Stella Tsui | Physical Therapy Assistant | 3818 Chanterwood Trl, Ooltewah, TN 37363 | 2016-10-14 |
| 1013392299 | Rhonda Wilson | Counselor | 5516 Barons Point, Ooltewah, TN 37363 | 2015-07-29 |
| Find all providers in zip 37363 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194069948 | Leah Suzanne Jarrell | Nurse Practitioner | 5602 Hunter Rd, Ooltewah, TN 37363-8746 | 2012-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750982658 | Kirsten Marie Doerfer | Nurse Practitioner | 8512 Golden Cloud Ln, Knoxville, TN 37931-3164 | 2020-11-06 |
| 1912506551 | Anna Simpson Jones | Nurse Practitioner | 1042 E 3rd St Ste 103, Chattanooga, TN 37403-2161 | 2020-10-24 |
| 1033724349 | Tatum Lee Severino I | Nurse Practitioner | 8819 Three Chimneys Dr E, Germantown, TN 38138-8206 | 2020-09-14 |
| 1871106930 | Munira Asif | Nurse Practitioner | 874 Schilling Farm Rd Apt 106, Collierville, TN 38017-7039 | 2020-08-28 |
| 1669000840 | Tekeyla Warfield | Nurse Practitioner | 2980 Poplar Ave, Memphis, TN 38111-3527 | 2020-04-01 |
| 1578197836 | Jessica Pratt | Nurse Practitioner | 512 Marbury Rd, Tullahoma, TN 37388-2142 | 2020-02-26 |
| 1730729278 | Anna Abigail Markus | Nurse Practitioner | 211 Long Branch Rd, Lawrenceburg, TN 38464-5400 | 2020-01-13 |
| 1023653037 | Staci Garner | Nurse Practitioner | 2508 Highway 130, Petersburg, TN 37144-8001 | 2019-11-13 |
| 1881238533 | Janna Rae Haskins | Nurse Practitioner | 5137 Vinnie Dell Drive, Chapel Hill, TN 37034 | 2019-11-05 |
| 1124676325 | Marde M Walker | Nurse Practitioner | 8225 Highway 51 North, Millington, TN 38053 | 2019-08-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.