=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821162264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEROPSYCH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5364 VILLAGE WAY
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-6234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-573-8069
-----------------------------------------------------
Fax | 615-333-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5364 VILLAGE WAY
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-6234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-573-8069
-----------------------------------------------------
Fax | 615-333-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. NORMAN KORTNER NYGARD
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 615-289-3928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------