Provider Demographics
NPI:1417108259
Name:EASLEY, LOREE A (PA-C)
Entity Type:Individual
Prefix:
First Name:LOREE
Middle Name:A
Last Name:EASLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LOREE
Other - Middle Name:E
Other - Last Name:AINSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6644 SUMMER KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2875
Mailing Address - Country:US
Mailing Address - Phone:901-372-4545
Mailing Address - Fax:901-372-4310
Practice Address - Street 1:6644 SUMMER KNOLL CIR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2875
Practice Address - Country:US
Practice Address - Phone:901-372-4545
Practice Address - Fax:901-372-4310
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant