Healthcare Provider Details

I. General information

NPI: 1942166483
Provider Name (Legal Business Name): MARAE LYNN NOLAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N CHARLES G SEIVERS BLVD
CLINTON TN
37716-6738
US

IV. Provider business mailing address

2200 N CHARLES G SEIVERS BLVD
CLINTON TN
37716-6738
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3200
  • Fax: 855-457-1556
Mailing address:
  • Phone: 865-647-3200
  • Fax: 855-457-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN40989
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: