Provider Demographics
NPI:1679504765
Name:MILEY, LEZLIE MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:MICHELLE
Last Name:MILEY
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 1:2067 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4090
Mailing Address - Country:US
Mailing Address - Phone:615-794-1814
Mailing Address - Fax:615-794-1840
Practice Address - Street 1:1614 WELLINGTON GRN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5359
Practice Address - Country:US
Practice Address - Phone:615-794-1814
Practice Address - Fax:615-372-0471
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007272363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648655Medicaid
TN3648655Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN3648655Medicaid