Provider Demographics
NPI:1215589635
Name:WINCHESTER, NICHOLAS COLT (NP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:COLT
Last Name:WINCHESTER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3962
Mailing Address - Country:US
Mailing Address - Phone:615-382-7284
Mailing Address - Fax:615-382-8231
Practice Address - Street 1:212 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3962
Practice Address - Country:US
Practice Address - Phone:615-382-7284
Practice Address - Fax:615-382-8231
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ054247Medicaid