Provider Demographics
NPI:1154637874
Name:LASHLEY, GLENNA WILLIS (NP-C)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:WILLIS
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WESTFIELD PL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5144
Mailing Address - Country:US
Mailing Address - Phone:423-939-0525
Mailing Address - Fax:423-939-0378
Practice Address - Street 1:503 WESTFIELD PL
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-5144
Practice Address - Country:US
Practice Address - Phone:423-939-0525
Practice Address - Fax:423-939-0378
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173610 NP363LF0000X
TN18102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015651Medicaid