Healthcare Provider Details

I. General information

NPI: 1447735311
Provider Name (Legal Business Name): NIKKI REALIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GREAT CIRCLE RD FL 3
NASHVILLE TN
37228-1317
US

IV. Provider business mailing address

1100 ENGLAND DR
COOKEVILLE TN
38501-0924
US

V. Phone/Fax

Practice location:
  • Phone: 888-605-9060
  • Fax:
Mailing address:
  • Phone: 931-520-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: