Provider Demographics
NPI:1922044056
Name:NUSSBAUMER-STORY, HEIDI R (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:R
Last Name:NUSSBAUMER-STORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:647 DUNLOP LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-551-8991
Practice Address - Fax:931-551-4053
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN127389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6046859OtherBCBS
TNQ015246Medicaid
P17078Medicare UPIN
TN6046859OtherBCBS