Doctor Name: | MISS LESLIE LYNETTE MYERS |
NPI Number: | 1053780478 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 20413 |
Business Practice Address: | 711 Nw Atlantic St Tullahoma, TN - 373883562 |
Business Phone Number: | 9314552273 |
Business Fax Number: | |
Mailing Address: | 5833 Aedc Rd, ESTILL SPRINGS |
State: | TN |
Postal Code: | 373303915 |
Phone Number: | 9313924169 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2015 |
NPI Last Update Date: | 03/01/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 20413 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |