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Organization
WESTSIDE FAMILY MEDICAL
Active
Organization
WESTSIDE FAMILY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE LYNETTE MYERS NP (NURSE PRACTITIONER)
(931) 636-3176
Entity
Organization
Contact information
Practice address
104 WESTSIDE DR, TULLAHOMA, TN 37388-3253
(931) 636-3176
Mailing address
160 CRESTVIEW DR, WINCHESTER, TN 37398-2566
(931) 636-3176
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
19352
TN
363LF0000X
Family Nurse Practitioner
Primary
20413
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053780478
—
TN
05
—
1255720421
—
TN
Enumeration date
07/13/2017
Last updated
07/13/2017
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