Provider Demographics
NPI:1982795720
Name:LEIDY, KAREN
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:LEIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:LEIDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:515 VICKSBURG CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4247
Mailing Address - Country:US
Mailing Address - Phone:615-225-4830
Mailing Address - Fax:615-225-2918
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-225-4830
Practice Address - Fax:615-225-2918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013273363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health