Edna R Leitherland, FNP APN
Individual provider Active NPI Nurse Practitioner · Dyer, TN
NPI 1942294574 · NPPES record last updated Apr 24, 2008
Key facts
- NPI
- 1942294574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN53289 (TN)
- Practice address
- 1123 N Main St
Dyer, TN 38330-1019 - Phone
- (731) 692-2853
- Fax
- (731) 692-2367
- NPI assigned
- Sep 9, 2005
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN5603 | TN | MD | Nurse Practitioner |
| RN53289 | TN | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN5603 | TN | |
| Nurse Practitioner | 363L00000X | RN53289 | TN | Yes |
Addresses
Primary practice location
1123 N Main St
Dyer, TN 38330-1019
Mailing address
1123 N Main St
Dyer, TN 38330-1019
Phone (731) 692-2853
Other providers in Dyer, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.