Healthcare Provider Details

I. General information

NPI: 1508668047
Provider Name (Legal Business Name): LILLIAN BRADY LADUKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LILLIAN TAYLOR PHILPOT

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

4610 COOKEVILLE BOAT DOCK RD
BAXTER TN
38544-4912
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2541
  • Fax:
Mailing address:
  • Phone: 931-260-6449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number269746
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: