Provider Demographics
NPI:1891330817
Name:RAU, NICHCOLE (NP)
Entity Type:Individual
Prefix:
First Name:NICHCOLE
Middle Name:
Last Name:RAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TYLER RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-7159
Mailing Address - Country:US
Mailing Address - Phone:731-614-5405
Mailing Address - Fax:
Practice Address - Street 1:36 PEMBERTON CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-5514
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:844-374-0233
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily