Provider Demographics
NPI:1154351278
Name:CRESS, FAWN (FNP)
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:
Last Name:CRESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 N HOUSTON LEVEE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6687
Mailing Address - Country:US
Mailing Address - Phone:901-421-5000
Mailing Address - Fax:901-227-0499
Practice Address - Street 1:1204 N HOUSTON LEVEE RD STE 114
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6687
Practice Address - Country:US
Practice Address - Phone:901-421-5000
Practice Address - Fax:901-901-5721
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09684770Medicaid
TN39951OtherTLC
TN4146160OtherBLUE CROSS BLUE SHIELD
TN3348474Medicare PIN
TN39951OtherTLC
TNSO0791Medicare UPIN