Organization Name: | LAKESIDE MEDICAL, PLLC |
NPI Number: | 1962802009 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTIN BELCHER (OWNER/FNP) |
Mailing Address: | 111 W Meeting Street Dandridge |
State: | TN US |
Postal Code: | 37725 |
Phone Number: | 8652543300 |
Fax Number: | |
NPI Enumeration Date: | 08/26/2014 |
NPI Last Update Date: | 10/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16734 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |