Healthcare Provider Details

I. General information

NPI: 1518650241
Provider Name (Legal Business Name): KATHRYN PAGE IMPERIAL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 PATTERSON ST
NASHVILLE TN
37203-1551
US

IV. Provider business mailing address

205 COPLEY LN
NASHVILLE TN
37204-3245
US

V. Phone/Fax

Practice location:
  • Phone: 615-457-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number33691
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: