Provider Demographics
NPI:1023745965
Name:PAULSEN, ANDREW CLAYTON (AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLAYTON
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 CEDAR RETREAT LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-7703
Mailing Address - Country:US
Mailing Address - Phone:423-763-8850
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST STE C-520B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32166363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care