Provider Demographics
NPI:1477075752
Name:DEBORD, LANITA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LANITA
Middle Name:
Last Name:DEBORD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-1761
Mailing Address - Country:US
Mailing Address - Phone:865-280-1466
Mailing Address - Fax:865-280-1469
Practice Address - Street 1:705 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-1761
Practice Address - Country:US
Practice Address - Phone:865-280-1466
Practice Address - Fax:865-280-1469
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily