Provider Demographics
NPI:1972801405
Name:EASLEY DELONES FAMILY MEDICAL, INC.
Entity type:Organization
Organization Name:EASLEY DELONES FAMILY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-476-7777
Mailing Address - Street 1:1618 HIGHWAY 51 S
Mailing Address - Street 2:SUITE G
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3237
Mailing Address - Country:US
Mailing Address - Phone:901-476-7777
Mailing Address - Fax:901-476-0007
Practice Address - Street 1:1618 HIGHWAY 51 S
Practice Address - Street 2:SUITE G
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3237
Practice Address - Country:US
Practice Address - Phone:901-476-7777
Practice Address - Fax:901-476-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532690Medicaid