Provider Demographics
NPI:1396418992
Name:WIDRICK, RACHEL LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LOUISE
Last Name:WIDRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROVIDENCE TRL APT 5314
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6531
Mailing Address - Country:US
Mailing Address - Phone:607-240-9443
Mailing Address - Fax:
Practice Address - Street 1:200 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37201-1613
Practice Address - Country:US
Practice Address - Phone:615-284-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily