Provider Demographics
NPI:1881137735
Name:LANNOM, MYCHELE (NP)
Entity type:Individual
Prefix:MRS
First Name:MYCHELE
Middle Name:
Last Name:LANNOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 JAN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1912
Mailing Address - Country:US
Mailing Address - Phone:317-498-6681
Mailing Address - Fax:
Practice Address - Street 1:111 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8682
Practice Address - Country:US
Practice Address - Phone:931-648-7615
Practice Address - Fax:931-648-7616
Is Sole Proprietor?:No
Enumeration Date:2016-11-27
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily