Healthcare Provider Details

I. General information

NPI: 1376731364
Provider Name (Legal Business Name): LESLEY K DAVIDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WASHINGTON ST W STE A
FAYETTEVILLE TN
37334-2872
US

IV. Provider business mailing address

1000 WASHINGTON ST W STE A
FAYETTEVILLE TN
37334-2872
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-3231
  • Fax: 931-438-1567
Mailing address:
  • Phone: 931-433-3231
  • Fax: 931-438-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000141418
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: