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NPI Code Detail

MEDICARE: MRS. LESLEY ANNE PULLIAM RN

MEDICARE: MRS. LESLEY ANNE PULLIAM RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0200XCritical Care Medicine Registered Nurse250938TN
2390200000XStudent in an Organized Health Care Education/Training Program250938TN

General Provider Information

NPI Number : 1912834136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLEY ANNE PULLIAM RN
Provider Business Mailing Address
First Line : 180 REBA RD
Second Line :
City : SOMERVILLE
State : TN
Zip : 38068-5565
Country : US
Telephone Number : 731-541-5000
Fax Number :
Provider Business Practice Location Address
First Line : 620 SKYLINE DR
Second Line :
City : JACKSON
State : TN
Zip : 38301-3923
Country : US
Telephone Number : 731-541-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/14/2026

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