Provider Demographics
NPI:1649407750
Name:BURDEN, LEZLIE WILLIAMS (PA-C)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:WILLIAMS
Last Name:BURDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-3750
Mailing Address - Country:US
Mailing Address - Phone:931-232-5141
Mailing Address - Fax:931-232-3905
Practice Address - Street 1:1020 MOORE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3750
Practice Address - Country:US
Practice Address - Phone:931-232-5141
Practice Address - Fax:931-232-3905
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant