Provider Demographics
NPI:1134303829
Name:BROWN, LAYTHEATER MICHELLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LAYTHEATER
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:931-436-0628
Mailing Address - Fax:270-461-1157
Practice Address - Street 1:215 DUNBAR CAVE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8850
Practice Address - Country:US
Practice Address - Phone:931-648-0202
Practice Address - Fax:931-538-6040
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily