Individual
ANTHONY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
238 SUMMAR DR, JACKSON, TN 38301-3906
(731) 935-8200
(731) 935-8327
Mailing address
1804 HIGHWAY 45 BYP, STE 604, JACKSON, TN 38305-4436
(731) 660-8755
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
6581
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6581
TN
Other
Enumeration date
07/03/2006
Last updated
10/29/2014
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