Provider Demographics
NPI:1295071736
Name:RISSLER, CAITLIN NICHOLL (PNP)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:NICHOLL
Last Name:RISSLER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5409 MARYLAND WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5037
Mailing Address - Country:US
Mailing Address - Phone:615-373-9955
Mailing Address - Fax:615-373-2001
Practice Address - Street 1:5409 MARYLAND WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5037
Practice Address - Country:US
Practice Address - Phone:615-373-9955
Practice Address - Fax:615-373-2001
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN21660363LP0200X
NC5005998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics