Provider Demographics
NPI:1295822997
Name:TREAKLE, LAWRIE NICHOLSON (CPNP)
Entity Type:Individual
Prefix:
First Name:LAWRIE
Middle Name:NICHOLSON
Last Name:TREAKLE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:LAWRIE
Other - Middle Name:J
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:2100 W. CLINCH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2219
Mailing Address - Country:US
Mailing Address - Phone:865-637-7290
Mailing Address - Fax:865-637-7289
Practice Address - Street 1:2100 W. CLINCH AVE STE 120
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-637-7290
Practice Address - Fax:865-637-7289
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN146011363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDAPN0000012083OtherADVANCED PRACTICE NURSE