Provider Demographics
NPI:1982830915
Name:SUBLETTE, NINA KATHERINE (PHD, FNP)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:KATHERINE
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 EAST DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-1711
Mailing Address - Country:US
Mailing Address - Phone:901-323-2263
Mailing Address - Fax:901-595-5068
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:ATTN: PROVIDER ENROLLMENT
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-515-3800
Practice Address - Fax:901-302-2491
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6607363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner