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General NPI Number Information
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NPI Number | 1538520812
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Entity Type | Individual
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Provider Name | LAURA KALEIGH MUNDY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2500 JACKSBORO PIKE STE 6
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City | JACKSBORO
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State | TN
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Zip | 37757-2818
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Country | US
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Telephone | 423-352-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 440 WALDEN LN
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City | LA FOLLETTE
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State | TN
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Zip | 37766-5026
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Country | US
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Telephone | 423-201-9937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0000021023
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License Number State | TN
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