Provider Demographics
NPI:1366944514
Name:UMSTEAD, NICOLE H (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:H
Last Name:UMSTEAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2313
Mailing Address - Country:US
Mailing Address - Phone:731-989-2829
Mailing Address - Fax:731-520-0230
Practice Address - Street 1:111 FRONT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2313
Practice Address - Country:US
Practice Address - Phone:731-989-2829
Practice Address - Fax:731-520-0230
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23868363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034933Medicaid