Basic Information
| Provider Information | |||||||||
| NPI: | 1164422655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLSON | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | PITTMAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10988 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379390988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658620998 | ||||||||
| FaxNumber: | 8655441861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 OLD WEISGARBER RD | ||||||||
| Address2: | SUTIE 200 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659345800 | ||||||||
| FaxNumber: | 8659345801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD0000026965 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 37952 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 9400654 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3823592 | 05 | TN | MEDICAID | 64721392 | 05 | KY | MEDICAID |