Healthcare Provider Details

I. General information

NPI: 1871974857
Provider Name (Legal Business Name): KERRIE WILDER RN,MS,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRIE TOLLERUD RN,MS,CNM

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S PERIMETER PARK DR STE 100
NASHVILLE TN
37211-4128
US

IV. Provider business mailing address

304 W KIRKFIELD DR
CARY NC
27518-6821
US

V. Phone/Fax

Practice location:
  • Phone: 615-478-6748
  • Fax:
Mailing address:
  • Phone: 708-768-1470
  • Fax: 800-308-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number309014
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4704287176
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number35381
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number35381
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: