Provider Demographics
NPI:1417938432
Name:ENDSLEY, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:ENDSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LANDRUM PLACE
Mailing Address - Street 2:STE 100
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-245-2090
Mailing Address - Fax:931-245-2091
Practice Address - Street 1:311 LANDRUM PLACE
Practice Address - Street 2:STE 100
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-245-2090
Practice Address - Fax:931-245-2091
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN23560207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3892497Medicaid
TN3892498Medicaid
TN3892497Medicaid
A48939Medicare UPIN
TN3892498Medicare ID - Type Unspecified