Basic Information
| Provider Information | |||||||||
| NPI: | 1023745965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULSEN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | CLAYTON | ||||||||
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| Credential: | AG-ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8551 CEDAR RETREAT LN | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373417703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237638850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 979 E 3RD ST STE C-520B | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237785661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 32166 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.