Provider Demographics
NPI:1144735549
Name:PETTY, LESLIE MEGAN (NP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MEGAN
Last Name:PETTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:MEGAN
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4007 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2013
Mailing Address - Country:US
Mailing Address - Phone:615-367-1444
Mailing Address - Fax:
Practice Address - Street 1:4220 HARDING PIKE STE 401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-6618
Practice Address - Fax:615-222-6074
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000188069163W00000X
TNAPN0000023468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse