Provider Demographics
NPI:1689394157
Name:TAYLOR, LEAH LENNETT (CNW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:LENNETT
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 MT PINSON RD
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:TN
Mailing Address - Zip Code:38391-1880
Mailing Address - Country:US
Mailing Address - Phone:731-300-7117
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29483367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife