Provider Demographics
NPI:1457628265
Name:SCHALLENBERGER, KAITLYN (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SCHALLENBERGER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:KILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 WOODMONT BLVD
Mailing Address - Street 2:SUITE LL50
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-386-2361
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 503
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-964-5864
Practice Address - Fax:615-386-2399
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000178692163W00000X
TN0000016224363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532141Medicaid
TN10350I0661Medicare PIN