Provider Demographics
NPI:1487612818
Name:CARLSON, PERRY ALBERT (RN, CPNP)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:ALBERT
Last Name:CARLSON
Suffix:
Gender:M
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:310 25TH AVE N
Mailing Address - Street 2:STE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-329-0195
Mailing Address - Fax:615-329-0211
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:STE 150
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-2990
Practice Address - Fax:615-302-4638
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015982363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09584287Medicaid
TNQOO9646Medicaid
MS09584287Medicaid