Healthcare Provider Details

I. General information

NPI: 1497329759
Provider Name (Legal Business Name): PAUL B BERTRAM APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

PO BOX 80426
CHATTANOOGA TN
37414-7426
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-2525
  • Fax:
Mailing address:
  • Phone: 423-495-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP004038
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number38904
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3015953
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: