Provider Demographics
NPI:1992708911
Name:RUSSELL, NATHAN W (FNP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:W
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2520
Mailing Address - Country:US
Mailing Address - Phone:615-822-3000
Mailing Address - Fax:615-822-0073
Practice Address - Street 1:166 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2520
Practice Address - Country:US
Practice Address - Phone:615-822-3000
Practice Address - Fax:615-822-0073
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN113668363L00000X
TNAPN7542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3900616 (3159250)Medicaid
TN3900616Medicare PIN
TN3900616 (3159250)Medicaid