Provider Demographics
NPI:1104191055
Name:NELSON, LEAH WELBOURN (NP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:WELBOURN
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6511
Mailing Address - Country:US
Mailing Address - Phone:615-515-1900
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON ST STE 502
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6511
Practice Address - Country:US
Practice Address - Phone:615-515-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-11
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16563363LF0000X
MDR200653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily