Provider Demographics
NPI:1174007355
Name:NICHOLSON, KAYLEE BREANNE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:BREANNE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAYLEE
Other - Middle Name:BREANNE
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:101 OKOLONA DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1387
Mailing Address - Country:US
Mailing Address - Phone:423-743-9103
Mailing Address - Fax:
Practice Address - Street 1:101 OKOLONA DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1387
Practice Address - Country:US
Practice Address - Phone:423-743-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN230562163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health