MEDICARE: JACKSON NOLDE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	41224	TN

General Provider Information

NPI Number	:	1134071855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON NOLDE NP

Provider Business Mailing Address
First Line	:	69B DONELSON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-4201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-3100
Country	:	US
Telephone Number	:	615-443-4994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/15/2026

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Directions to “ JACKSON NOLDE NP” Practice Location

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