Healthcare Provider Details

I. General information

NPI: 1912525049
Provider Name (Legal Business Name): COLLEEN MICHELLE CLARK LAING NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W 4TH NORTH ST
MORRISTOWN TN
37814-3894
US

IV. Provider business mailing address

908 W 4TH NORTH ST
MORRISTOWN TN
37814-3894
US

V. Phone/Fax

Practice location:
  • Phone: 423-492-6100
  • Fax: 423-492-6101
Mailing address:
  • Phone: 423-492-6100
  • Fax: 423-492-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000113128
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: