Provider Demographics
NPI:1003110859
Name:HETTINGER, NICHOLE RENAE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENAE
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S DICKERSON RD APT 145
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1737
Mailing Address - Country:US
Mailing Address - Phone:615-668-9106
Mailing Address - Fax:
Practice Address - Street 1:1921 RANSOM PLACE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37011
Practice Address - Country:US
Practice Address - Phone:615-463-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator