Provider Demographics
NPI:1063523868
Name:NICKELL, KAREN K (FNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:K
Last Name:NICKELL
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 1:1275 DICK LONAS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1382
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:11808 KINGSTON PIKE
Practice Address - Street 2:SUITE 160
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3838
Practice Address - Country:US
Practice Address - Phone:865-966-3940
Practice Address - Fax:865-966-6914
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000125136OtherSTATE LICENSE NO
TN3714824OtherMEDICARE LEGACY GROUP
TNAPN0000007958OtherADVANCED PRACTICE NURSE
TNRN0000125136OtherSTATE LICENSE NO