Provider Demographics
NPI:1417404666
Name:MUSIC CITY PEDS: DEVELOPMENTAL & BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:MUSIC CITY PEDS: DEVELOPMENTAL & BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:NICHOLL
Authorized Official - Last Name:RISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-207-7986
Mailing Address - Street 1:5409 MARYLAND WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5037
Mailing Address - Country:US
Mailing Address - Phone:615-373-9955
Mailing Address - Fax:615-373-2001
Practice Address - Street 1:5409 MARYLAND WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5037
Practice Address - Country:US
Practice Address - Phone:615-373-9955
Practice Address - Fax:615-373-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21660261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty