Provider Demographics
NPI:1851835524
Name:LAY, ERIN GRACE (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:LAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0278
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:1206 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2455
Practice Address - Country:US
Practice Address - Phone:423-884-7271
Practice Address - Fax:423-884-3277
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN182209163W00000X
TN22106363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025836Medicaid
TN13942782OtherCAQH
TN10350I4782Medicare PIN