Healthcare Provider Details

I. General information

NPI: 1366135212
Provider Name (Legal Business Name): LAXMI SHRESTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 W MAIN ST
LEBANON TN
37087-1323
US

IV. Provider business mailing address

1436 W MAIN ST
LEBANON TN
37087-1323
US

V. Phone/Fax

Practice location:
  • Phone: 615-965-6108
  • Fax: 877-504-1444
Mailing address:
  • Phone: 615-965-6108
  • Fax: 877-504-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number247345
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: