Provider Demographics
NPI:1639123201
Name:TREVATHAN, LINDA S (RN, NURSE PRACTITION)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:TREVATHAN
Suffix:
Gender:F
Credentials:RN, NURSE PRACTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5307
Mailing Address - Country:US
Mailing Address - Phone:615-227-3000
Mailing Address - Fax:615-678-7641
Practice Address - Street 1:2711 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-5307
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:615-678-7641
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150915363LF0000X
TXAP129453363LF0000X
TN21309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP27328Medicare UPIN