Basic Information
| Provider Information | |||||||||
| NPI: | 1013996222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUST | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | CHANNING | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 25TH AVE N | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153120600 | ||||||||
| FaxNumber: | 6153203259 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 25TH AVE N | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153120600 | ||||||||
| FaxNumber: | 6153203259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA885 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Q001867 | 05 | TN | MEDICAID |