Healthcare Provider Details

I. General information

NPI: 1942011143
Provider Name (Legal Business Name): LENTZ PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SECURITY DR
JACKSON TN
38305-3626
US

IV. Provider business mailing address

19 SECURITY DR
JACKSON TN
38305-3626
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-9040
  • Fax: 731-664-9040
Mailing address:
  • Phone: 731-664-9040
  • Fax: 731-664-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY CHESSER
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-664-9040