Healthcare Provider Details

I. General information

NPI: 1952852980
Provider Name (Legal Business Name): BAMBI LAFONT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176C W UNIVERSITY PKWY # C
JACKSON TN
38305-1616
US

IV. Provider business mailing address

400 US HIGHWAY 45 W
HUMBOLDT TN
38343-8503
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6915
  • Fax: 731-668-4557
Mailing address:
  • Phone: 731-784-7773
  • Fax: 731-784-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000021896
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: