Provider Demographics
NPI:1073546974
Name:CARLSON, KAMI DICKSON (ANP)
Entity Type:Individual
Prefix:MS
First Name:KAMI
Middle Name:DICKSON
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:KAMI
Other - Middle Name:DICKSON
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:201 JORDAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4495
Mailing Address - Country:US
Mailing Address - Phone:615-905-5461
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-679-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10489363LA2200X
AZAP2090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341161Medicare PIN
AZZ126030Medicare PIN