Provider Demographics
NPI:1568637288
Name:HERRING, LELA SAMPSON (APN)
Entity Type:Individual
Prefix:MRS
First Name:LELA
Middle Name:SAMPSON
Last Name:HERRING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N DUNLAP ST STE 235
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4625
Mailing Address - Country:US
Mailing Address - Phone:901-287-5316
Mailing Address - Fax:901-287-4434
Practice Address - Street 1:51 N DUNLAP ST STE 235
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-287-5316
Practice Address - Fax:901-287-4434
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197570758Medicaid
MS07751241Medicaid
TN1509076Medicaid