Provider Demographics
NPI:1508856873
Name:NITZ, GRETCHEN JILLIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:JILLIAN
Last Name:NITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FRANK L DIGGS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6953
Mailing Address - Country:US
Mailing Address - Phone:865-647-3320
Mailing Address - Fax:865-647-3329
Practice Address - Street 1:919 E CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2778
Practice Address - Country:US
Practice Address - Phone:423-907-1740
Practice Address - Fax:423-907-1743
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3665540Medicaid
KYP400020947Medicare PIN
KYK024500Medicare PIN
TNR60762Medicare UPIN
KY0644808Medicare PIN
P00841556Medicare PIN