Provider Demographics
NPI:1396804266
Name:FLEMING, ANDRENETTE M (MD)
Entity type:Individual
Prefix:
First Name:ANDRENETTE
Middle Name:M
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BEN CV
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1278
Mailing Address - Country:US
Mailing Address - Phone:731-989-4339
Mailing Address - Fax:901-383-7447
Practice Address - Street 1:9005 HIGHWAY 64
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-8391
Practice Address - Country:US
Practice Address - Phone:901-383-7446
Practice Address - Fax:901-383-7447
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039552207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2033962OtherUNISON
TN39813OtherTLC
TN4143455OtherBCBS
MS5882244Medicaid
TN3833454Medicaid
TN3833454Medicare PIN
TN2033962OtherUNISON
TN4143455OtherBCBS