Individual provider Active NPI

Andrea Suzanne Proctor, NP

  • Family Nurse Practitioner
  • Nashville, TN
National Provider Identifier
1659864650
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10456 Issued in TN
Practice address
402 22ND Ave N
Nashville, TN 37203-1949
Phone
(615) 251-8805
NPI assigned
Jun 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024185100 VA
Family Nurse Practitioner 363LF0000X 10456 TN Primary

Addresses

Primary practice location

402 22ND Ave N
Nashville, TN 37203-1949

Mailing address

5511 Virginia Way
Ste 300
Brentwood, TN 37027-7611
Phone (615) 994-1000

Other practice location 1

5511 Virginia Way
STe 300
Brentwood, TN 37027-7611
Phone (615) 994-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230921002614 TN Practitioner - Nurse Practitioner 2769836972 Reassigns benefits to 1 organization
I20230929001940 VA Practitioner - Nurse Practitioner 2769836972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1512 Hatcher LN
Columbia, TN 38401-4825
Phone (931) 548-8882

170 Blevins Blvd
Bristol, VA 24202-6021
Phone (276) 285-3911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024185100VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cedar Recovery Center of Middle Tennessee, LLC CurrentSince Mar 27, 2024 Accepting new patients
Cedar Recovery of Middle Tennessee, LLC CurrentSince Mar 27, 2024 Accepting new patients

Locations

1512 Hatcher Ln
Columbia, TN 38401
Phone (615) 257-6844

2636 N Mount Juliet Rd
Mt Juliet, TN 37122
Phone (615) 680-0110

5000 Crossings Cir
Ste 103
Mt Juliet, TN 37122
Phone (615) 208-9549

170 Blevins Blvd
Bristol, VA 24202
Phone (276) 285-3911

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1659864650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 VIRGINIA WAY",
            "address_2": "STE 300",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277611",
            "telephone_number": "615-994-1000",
            "fax_number": "615-994-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 22ND AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031949",
            "telephone_number": "615-251-8805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5511 Virginia Way",
            "address_2": "STe 300",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "TN",
            "postal_code": "370277611",
            "country_code": "US",
            "telephone_number": "615-994-1000",
            "fax_number": "615-994-0100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "ANDREA",
        "middle_name": "SUZANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-13",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024185100",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "10456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.