Provider Demographics
NPI:1881618056
Name:RICHARDSON, NANCY TERRY (APRN,BC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:TERRY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:408 SOUTH MAIN STREET
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-0593
Mailing Address - Country:US
Mailing Address - Phone:931-268-9291
Mailing Address - Fax:931-268-2807
Practice Address - Street 1:142 W 5TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1760
Practice Address - Country:US
Practice Address - Phone:931-646-5721
Practice Address - Fax:931-646-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000038204OtherREGISTERED NURSE
TNAPN0000005241OtherNURSE PRACTITIONER WITH C