Provider Demographics
NPI:1427356344
Name:BYRD, MARY LEA (FNP-C, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEA
Last Name:BYRD
Suffix:
Gender:F
Credentials:FNP-C, MSN, RN
Other - Prefix:
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Mailing Address - Street 1:1864 HARBOUR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-4033
Mailing Address - Country:US
Mailing Address - Phone:865-988-8552
Mailing Address - Fax:865-988-4488
Practice Address - Street 1:1864 HARBOUR VIEW DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-4033
Practice Address - Country:US
Practice Address - Phone:865-988-8552
Practice Address - Fax:865-988-4488
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily