Provider Demographics
NPI:1609947142
Name:TEW, LEANNE LOTT (CRNP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:LOTT
Last Name:TEW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:LEANNE
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0908
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:1404 E PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2728
Practice Address - Country:US
Practice Address - Phone:205-459-4488
Practice Address - Fax:205-459-3010
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1075117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891001830Medicaid
ALP22665Medicare UPIN
AL515-48175OtherBCBS OF ALABAMA (DUVAL ST.)
AL515-48180OtherBCBS OF ALABAMA (SPRINGHILL)
ALP22665Medicare UPIN
AL1609947142Medicaid
AL891001830Medicaid
AL515-48174OtherBCBS OF ALABAMA (MLK)
AL515-48179OtherBCBS OF ALABAMA ( BISHOP AVE.)
AL515-481-78OtherBCBS OF ALABAMA (LOXLEY)
AL1609947142Medicare PIN
AL515-48176OtherBCBS OF ALABAMA (WILSON AVE., PRICHARD)
AL1075517OtherAL LICENSE