Provider Demographics
NPI:1265084016
Name:CHITWOOD, NATHAN BRYANT (NP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:BRYANT
Last Name:CHITWOOD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:NATHANIEL OR NATE
Other - Middle Name:BRYANT
Other - Last Name:CHITWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:645 OLD HICKORY BLVD APT 324
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5254
Mailing Address - Country:US
Mailing Address - Phone:775-247-4048
Mailing Address - Fax:
Practice Address - Street 1:280 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1552
Practice Address - Country:US
Practice Address - Phone:541-201-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905531NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner