Provider Demographics
NPI:1639486251
Name:PALLAS, LEA JAN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:JAN
Last Name:PALLAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 FOSTER CREIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3719
Mailing Address - Country:US
Mailing Address - Phone:185-549-3556
Mailing Address - Fax:
Practice Address - Street 1:2932 FOSTER CREIGHTON DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3719
Practice Address - Country:US
Practice Address - Phone:185-549-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily