Provider Demographics
NPI:1417198292
Name:MOTLEY, LUCINDA LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:LEE
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WISDOM WAY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8344
Mailing Address - Country:US
Mailing Address - Phone:615-459-5955
Mailing Address - Fax:
Practice Address - Street 1:6001 JACKSON SQUARE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086
Practice Address - Country:US
Practice Address - Phone:615-793-9900
Practice Address - Fax:615-793-9990
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1031508339OtherTPAN