Provider Demographics
NPI:1861630089
Name:KENNARD, LEIGH AYN
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:AYN
Last Name:KENNARD
Suffix:
Gender:F
Credentials:
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 440200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0200
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6188
Practice Address - Street 1:11606 CHAPMAN HWY
Practice Address - Street 2:STE 2
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5270
Practice Address - Country:US
Practice Address - Phone:865-579-7580
Practice Address - Fax:865-609-6982
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily