Provider Demographics
NPI:1578173795
Name:DELOACH, CHARLSIE (FNP-CB)
Entity Type:Individual
Prefix:
First Name:CHARLSIE
Middle Name:
Last Name:DELOACH
Suffix:
Gender:F
Credentials:FNP-CB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HAYES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2659
Mailing Address - Country:US
Mailing Address - Phone:931-906-2004
Mailing Address - Fax:931-906-2009
Practice Address - Street 1:776 WEATHERLY DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8921
Practice Address - Country:US
Practice Address - Phone:931-906-2004
Practice Address - Fax:931-906-2009
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014867363LF0000X
TN27927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily