Healthcare Provider Details

I. General information

NPI: 1922187715
Provider Name (Legal Business Name): SUSAN KAY NELSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL ST SUITE 200
COOKEVILLE TN
38501-0944
US

IV. Provider business mailing address

1080 NEAL ST SUITE 200
COOKEVILLE TN
38501-0944
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-1529
  • Fax: 931-372-2751
Mailing address:
  • Phone: 931-520-1529
  • Fax: 931-372-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN15448
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2006032072
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: