Provider Demographics
NPI:1972827251
Name:EASLEY, JENNIFER LEIGH (MSN, APN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 HIGHWAY 51 S
Mailing Address - Street 2:SUITE G
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3237
Mailing Address - Country:US
Mailing Address - Phone:901-476-7777
Mailing Address - Fax:901-476-0007
Practice Address - Street 1:1618 HIGHWAY 51 S
Practice Address - Street 2:SUITE G
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3237
Practice Address - Country:US
Practice Address - Phone:901-476-7777
Practice Address - Fax:901-476-0007
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532694Medicaid