Provider Demographics
NPI:1053819060
Name:LEPHEW, KASSANDRA SUZANNE (LPN)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:SUZANNE
Last Name:LEPHEW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:SUZANNE
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6350 W ANDREW JOHNSON HWY DEPT 100
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8605
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:150 PIONEER DR
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-3622
Practice Address - Country:US
Practice Address - Phone:865-225-2188
Practice Address - Fax:865-225-2189
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN65437164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse