Provider Demographics
NPI:1700369162
Name:HUNLEY, LAUREN PEYTON (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PEYTON
Last Name:HUNLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6890 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8610
Mailing Address - Country:US
Mailing Address - Phone:423-839-2120
Mailing Address - Fax:
Practice Address - Street 1:6890 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8610
Practice Address - Country:US
Practice Address - Phone:423-839-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA3709363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044056Medicaid
TN6171444OtherPHYSICIAN ASSISTANT