Provider Demographics
NPI:1831553833
Name:LEGRONE, FAITH OLIVER (FNP)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:OLIVER
Last Name:LEGRONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N ELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2227
Mailing Address - Country:US
Mailing Address - Phone:931-359-6241
Mailing Address - Fax:
Practice Address - Street 1:1080 N ELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2227
Practice Address - Country:US
Practice Address - Phone:931-359-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily