Healthcare Provider Details

I. General information

NPI: 1538987300
Provider Name (Legal Business Name): LUCY ABIGAIL DESPAIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 HIGHWAY 51 S STE A
COVINGTON TN
38019-3604
US

IV. Provider business mailing address

1999 HIGHWAY 51 S STE A
COVINGTON TN
38019-3604
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-0235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number279503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: