Provider Demographics
NPI:1316525959
Name:JEFFERSON, LASHANDA IDA (APRN)
Entity type:Individual
Prefix:
First Name:LASHANDA
Middle Name:IDA
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LASHANDA
Other - Middle Name:IDA
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:776 WEATHERLY DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8922
Mailing Address - Country:US
Mailing Address - Phone:615-941-8538
Mailing Address - Fax:
Practice Address - Street 1:776 WEATHERLY DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8922
Practice Address - Country:US
Practice Address - Phone:270-987-0819
Practice Address - Fax:615-941-8538
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015985363LF0000X
TN29424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily