Provider Demographics
NPI:1629604566
Name:LAWSON, LESSLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LESSLEY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7718
Mailing Address - Country:US
Mailing Address - Phone:901-626-9022
Mailing Address - Fax:
Practice Address - Street 1:1213 RIDGEWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5316
Practice Address - Country:US
Practice Address - Phone:901-509-8205
Practice Address - Fax:901-509-8708
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-22
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27805363LF0000X
TN137499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN050977Medicaid