Provider Demographics
NPI:1538520812
Name:MUNDY, LAURA KALEIGH (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KALEIGH
Last Name:MUNDY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 WALDEN LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-5026
Mailing Address - Country:US
Mailing Address - Phone:423-201-9937
Mailing Address - Fax:
Practice Address - Street 1:2500 JACKSBORO PIKE STE 6
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2818
Practice Address - Country:US
Practice Address - Phone:423-352-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000021023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily