Provider Demographics
NPI:1134293806
Name:MCCORMICK, JANICE KAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:KAY
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PALESTINE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351
Mailing Address - Country:US
Mailing Address - Phone:731-968-7853
Mailing Address - Fax:731-968-6258
Practice Address - Street 1:1560 NORTH BROAD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4765
Practice Address - Country:US
Practice Address - Phone:731-967-8813
Practice Address - Fax:731-967-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily