MEDICARE: TERESA NICHOLS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	215825	TN

General Provider Information

NPI Number	:	1962337931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA NICHOLS RN

Provider Business Mailing Address
First Line	:	310 W 3RD NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4038
Country	:	US
Telephone Number	:	423-581-4671
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 W 3RD NORTH ST
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-4038
Country	:	US
Telephone Number	:	423-581-4671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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