KETSANA BOUTTAVONG (NPI# 1932737954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932737954 |
| Entity Type | Individual |
| Full Name | KETSANA BOUTTAVONG |
| Credential | PMHNP-BC |
| Practice Address |
221 Stewarts Ferry Pike Nashville TN 37214-3325 |
| Practice Telephone | 6154742266 |
| Mailing Telephone | 6154742266 |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2020-03-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
27016 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
221 STEWARTS FERRY PIKE |
| City | NASHVILLE |
| State | TN |
| Zip Code | 37214-3325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659351542 | Gamal S Eskander | Family Medicine | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2006-01-18 |
| 1023659539 | Maycelin Ramos | Nurse Practitioner | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2019-10-06 |
| 1285280909 | Caitlin Marie Wise | Pharmacist | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2019-08-18 |
| 1417450925 | Karen Haynes Hollis | Social Worker | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2018-03-10 |
| 1760900864 | Marianne Raynes | Psychiatry & Neurology | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2017-09-08 |
| 1639605710 | Jake Timian | Registered Nurse | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2017-05-10 |
| 1104287903 | Lance Morgan | Pharmacist | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2016-03-08 |
| 1619385788 | Debra Cathleen Poplar | Nurse Practitioner | 221 Stewarts Ferry Pike, Middle Tennessee Mental Health Institute, Nashville, TN 37214 | 2014-08-01 |
| 1871818856 | Mahshid Moradiseresht | Student in an Organized Health Care Education/Training Program | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2010-04-01 |
| 1437381217 | Elizabeth Brinton Hoover | Psychiatry & Neurology | 221 Stewarts Ferry Pike, Nashville, TN 37214-3325 | 2009-08-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679084123 | Paula Gardner-porter | Counselor | 1310 Peremiter Hill Dr, Nashville, TN 37214 | 2017-10-23 |
| 1811412612 | Laura Marie Stiles | Physician Assistant | 2630 Elm Hill Pk, Nashville, TN 37214 | 2017-08-14 |
| 1902348279 | Caresouth Hha Holdings of Winchester, LLC | Hospice Care, Community Based | 828 Royal Parkway, Suite 113, Nashville, TN 37214 | 2016-11-17 |
| 1861949547 | Roger P. Sherman, M.d., P.l.l.c. | Family Medicine | 211 Donelson Pike Ste 102, Nashville, TN 37214 | 2016-09-09 |
| 1023465143 | Sarah Carpenter | Speech-Language Pathologist | 3233 Lincoya Creek Drive, Nashville, TN 37214 | 2016-05-18 |
| 1306209861 | Shemicka Adams | Behavioral Analyst | 2996a Windemere Circle, Nashville, TN 37214 | 2016-04-01 |
| 1922483023 | Abigail Bargatze | Radiologic Technologist | 1708 Elm Run Way, Nashville, TN 37214 | 2015-07-30 |
| 1588045199 | Middle Tennessee Homes | Intermediate Care Facility, Mentally Retarded | 2410 Wilford Drive, Donelson, TN 37214 | 2015-06-10 |
| 1023499639 | Middle Tennessee Homes | Intermediate Care Facility, Mentally Retarded | 328 Dennywood Drive, Donelson, TN 37214 | 2015-06-10 |
| 1912387242 | Donelson Smiles Dentistry, PC | Dentist | 2340 Lebanon Pike, Nashville, TN 37214 | 2015-06-02 |
| Find all providers in zip 37214 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003479718 | Emily Barrington Burton | Nurse Practitioner | 3909 Whitland Ave Apt 101, Nashville, TN 37205-1938 | 2019-04-18 |
| 1326507633 | Cynthia Strother Terry | Nurse Practitioner | 924a Spain Ave, Nashville, TN 37216-3625 | 2019-03-16 |
| 1588148944 | Elizabeth C Lohr | Nurse Practitioner | 85 White Bridge Pike Ste 302, Nashville, TN 37205-1565 | 2018-09-21 |
| 1407215494 | Rachael Tanner-smith | Nurse Practitioner | 2323 21st Ave S Ste 300, Nashville, TN 37212-4930 | 2016-02-18 |
| 1033514773 | James Kelly Speck | Nurse Practitioner | 2831 Hillside Dr, Apt H-5, Nashville, TN 37212-4029 | 2014-10-23 |
| 1992145577 | Leslie Walls Binford | Nurse Practitioner | 2021 21st Ave S Ste 410, Nashville, TN 37212 | 2013-06-27 |
| 1336475581 | Wellness Solutions of Tennessee LLC | Nurse Practitioner | 2323 21st Ave S Ste 306, Nashville, TN 37212-4930 | 2009-10-22 |
| 1386760635 | Pamela Anne Nelson | Nurse Practitioner | 330 23rd Ave N Ste 140, Nashville, TN 37203-1536 | 2007-03-21 |
| 1023147766 | Joan Cornelia Mccuen | Nurse Practitioner | 2200 21st Ave S Ste 305, Nashville, TN 37212-4929 | 2007-03-05 |
| 1568597425 | Brandee J. Madden | Nurse Practitioner | 402 22nd Avenue N., Nashville, TN 37203 | 2007-02-22 |
| Find all providers in NASHVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.