Provider Demographics
NPI:1790206746
Name:HENNESSEY, LAURA ASHLEY (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ASHLEY
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4841 HIXSON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-771-7311
Mailing Address - Fax:
Practice Address - Street 1:4841 HIXSON PIKE STE A
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-305-7980
Practice Address - Fax:423-305-7981
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine