Provider Demographics
NPI:1972654374
Name:CRENSHAW, GWENDOLYN EMMA DUSO (APN, FNP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:EMMA DUSO
Last Name:CRENSHAW
Suffix:
Gender:
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207830
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7830
Mailing Address - Country:US
Mailing Address - Phone:888-412-2649
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:6473 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:75320
Practice Address - Country:US
Practice Address - Phone:865-588-8831
Practice Address - Fax:865-588-8841
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341414Medicaid
TN3341414OtherMEDICARE-PTAN
TN3341415OtherMEDICARE-PTAN