Provider Demographics
NPI:1184220956
Name:LEDFORD, JODI (NP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:LEDFORD
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 1:1323 CHRISTINE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5697
Mailing Address - Country:US
Mailing Address - Phone:615-504-9710
Mailing Address - Fax:
Practice Address - Street 1:6650 EASTGATE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-6018
Practice Address - Country:US
Practice Address - Phone:615-900-5451
Practice Address - Fax:615-900-5440
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily