Provider Demographics
NPI:1023865649
Name:LEMUSU, WILLIE LANCE (APRN)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:LANCE
Last Name:LEMUSU
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3437
Mailing Address - Country:US
Mailing Address - Phone:615-852-6256
Mailing Address - Fax:931-903-1200
Practice Address - Street 1:133 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3437
Practice Address - Country:US
Practice Address - Phone:615-852-6256
Practice Address - Fax:931-903-1200
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36228363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health