Provider Demographics
NPI:1083895023
Name:SPEIGHT FAMILY MEDICAL, LLC
Entity Type:Organization
Organization Name:SPEIGHT FAMILY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:KIMBERLIN
Authorized Official - Last Name:SPEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-840-2102
Mailing Address - Street 1:76 TABB DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058-8611
Mailing Address - Country:US
Mailing Address - Phone:901-840-2102
Mailing Address - Fax:901-840-1979
Practice Address - Street 1:76 TABB DR
Practice Address - Street 2:SUITE E
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-8611
Practice Address - Country:US
Practice Address - Phone:901-840-2102
Practice Address - Fax:901-840-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6874261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509248Medicaid
TN1770531766OtherNPI
TN5442117Medicaid
TN1679630891OtherNPI