Provider Demographics
NPI:1891711883
Name:LEMLEY, EDIE P (FNP)
Entity Type:Individual
Prefix:MRS
First Name:EDIE
Middle Name:P
Last Name:LEMLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 S FARMERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5941
Mailing Address - Country:US
Mailing Address - Phone:318-396-3800
Mailing Address - Fax:318-396-3852
Practice Address - Street 1:1809 NORTHPOINTE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3853
Practice Address - Country:US
Practice Address - Phone:318-255-3762
Practice Address - Fax:318-255-9970
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438430Medicaid
LA1438430Medicaid
P25521Medicare UPIN