Healthcare Provider Details

I. General information

NPI: 1992254239
Provider Name (Legal Business Name): MINDY LAFAYETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 02/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 ESTATE PL
MEMPHIS TN
38120-0600
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 662-681-4040
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-208-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901746
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: