Provider Demographics
NPI:1902128812
Name:LEZATTE, STEPHANIE K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:K
Last Name:LEZATTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 REGAL LANE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5804
Mailing Address - Country:US
Mailing Address - Phone:865-521-8050
Mailing Address - Fax:865-544-5816
Practice Address - Street 1:7680 DANNAHER DR.
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4052
Practice Address - Country:US
Practice Address - Phone:865-521-8050
Practice Address - Fax:865-544-5816
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1809363AS0400X
TNPA1809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518173Medicaid