Provider Demographics
NPI:1821054321
Name:LANKFORD, DODDIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DODDIE
Middle Name:
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-483-8478
Mailing Address - Fax:865-483-4194
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-483-8478
Practice Address - Fax:865-483-4194
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61126Medicare UPIN
3345724Medicare ID - Type Unspecified