Basic Information
| Provider Information | |||||||||
| NPI: | 1881969103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDFORD | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 N LOCUST AVE STE B | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384643516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317629797 | ||||||||
| FaxNumber: | 9317629798 | ||||||||
| Practice Location | |||||||||
| Address1: | 912 W COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | PULASKI | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384783630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314249797 | ||||||||
| FaxNumber: | 9314249788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 16588 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 16588 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.