Provider Demographics
NPI:1851404396
Name:ALGOOD, SUSAN LEIGH (CPNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEIGH
Last Name:ALGOOD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:200 GLEAVES STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-851-7865
Mailing Address - Fax:888-599-5833
Practice Address - Street 1:200 GLEAVES STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-851-7810
Practice Address - Fax:615-851-7866
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15080363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522189Medicaid