MEDICARE: DR. NIKKALYNN F DELAURENTIS DO

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	2144	TN

General Provider Information

NPI Number	:	1487678835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKKALYNN F DELAURENTIS DO

Provider Business Mailing Address
First Line	:	1960 MADISON ST STE J
Second Line	:	#296
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8039
Country	:	US
Telephone Number	:	219-218-9229
Fax Number	:	888-261-6219

Provider Business Practice Location Address
First Line	:	1960 MADISON ST STE J
Second Line	:	#296
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8039
Country	:	US
Telephone Number	:	219-218-9229
Fax Number	:	888-261-6219

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/09/2015

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