Provider Demographics
NPI:1528727138
Name:ANDERSON, NATASHA RENINA
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:RENINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 UNION ST STE 508
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1705
Mailing Address - Country:US
Mailing Address - Phone:615-930-7310
Mailing Address - Fax:
Practice Address - Street 1:501 UNION ST STE 508
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-1705
Practice Address - Country:US
Practice Address - Phone:615-930-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00000Medicaid