Provider Demographics
NPI:1811723612
Name:NICHOLSON, CATHERINE PORTER (PNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PORTER
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 VINTAGE POINTE WAY APT 812
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5634
Mailing Address - Country:US
Mailing Address - Phone:865-806-2430
Mailing Address - Fax:
Practice Address - Street 1:7503 VINTAGE POINTE WAY APT 812
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5634
Practice Address - Country:US
Practice Address - Phone:865-806-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36985363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics