Provider Demographics
NPI:1548537533
Name:RODRIGUEZ, DALTON PICKNEY (MSN APN ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:DALTON
Middle Name:PICKNEY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSN APN ACNP-BC
Other - Prefix:
Other - First Name:DALTON
Other - Middle Name:ELIZABETH
Other - Last Name:PICKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-515-1900
Mailing Address - Fax:615-292-4633
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-515-1900
Practice Address - Fax:615-292-4633
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15303363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527568Medicaid
TNPO1120793OtherRR MEDICARE
TN4324125OtherBLUE CROSS/BLUE SHIELD
TN103I503907Medicare PIN