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Individual

MRS. LEILA KEEL NICHOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
2863 HIGHWAY 45 BYP, JACKSON, TN 38305-3618
(731) 660-8300
(731) 660-8301
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 422-0213
(731) 425-5743

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
13090
TN
367A00000X
Advanced Practice Midwife
Primary
14288
TN
367A00000X
Advanced Practice Midwife
APN14288
TN
367A00000X
Advanced Practice Midwife
APRN90339MIDWIFE
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1525515
TN
01
3380640
MEDICARE GROUP
TN
Enumeration date
09/10/2009
Last updated
05/16/2022
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