Provider Demographics
NPI:1083673792
Name:FRANKLIN, LYDIA MARIE (PMHNP-BC,FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:PMHNP-BC,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 APPLE TREE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0300
Mailing Address - Country:US
Mailing Address - Phone:901-922-5951
Mailing Address - Fax:901-922-5952
Practice Address - Street 1:6063 MOUNT MORIAH ROAD EXT STE 4
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2665
Practice Address - Country:US
Practice Address - Phone:901-531-8800
Practice Address - Fax:901-531-8801
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS95007768363L00000X
MSR617601363LF0000X
TN5767363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533012Medicaid