Provider Demographics
NPI:1013911007
Name:GAYLORD, NAN M (PHD, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:M
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:PHD, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VOLUNTEER BLVD
Mailing Address - Street 2:UTCON #335
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-4180
Mailing Address - Country:US
Mailing Address - Phone:865-974-7622
Mailing Address - Fax:865-974-3569
Practice Address - Street 1:220 LANGLAND ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37915-1415
Practice Address - Country:US
Practice Address - Phone:865-594-5078
Practice Address - Fax:865-594-3921
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000044603163W00000X
TNAPN0000005409363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3497038Medicaid