Healthcare Provider Details

I. General information

NPI: 1689394157
Provider Name (Legal Business Name): LEAH LENNETT TAYLOR CNW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

2179 MT PINSON RD
DENMARK TN
38391-1880
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7100
  • Fax:
Mailing address:
  • Phone: 731-300-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number29483
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: