Provider Demographics
NPI:1356111728
Name:LAKE MED, PLLC
Entity type:Organization
Organization Name:LAKE MED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:931-998-2915
Mailing Address - Street 1:615 RIVER WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-3506
Mailing Address - Country:US
Mailing Address - Phone:931-998-2915
Mailing Address - Fax:931-998-2915
Practice Address - Street 1:615 RIVER WATCH WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-3506
Practice Address - Country:US
Practice Address - Phone:931-998-2915
Practice Address - Fax:931-998-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty