Provider Demographics
NPI:1962802009
Name:LAKESIDE MEDICAL, PLLC
Entity type:Organization
Organization Name:LAKESIDE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC
Authorized Official - Phone:865-397-6680
Mailing Address - Street 1:127 W MEETING ST
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4747
Mailing Address - Country:US
Mailing Address - Phone:865-397-6680
Mailing Address - Fax:
Practice Address - Street 1:127 W MEETING ST
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4747
Practice Address - Country:US
Practice Address - Phone:865-397-6680
Practice Address - Fax:865-397-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty