Basic Information
| Provider Information | |||||||||
| NPI: | 1942287610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDET | ||||||||
| FirstName: | DAVONNA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 N DUNLAP ST | ||||||||
| Address2: | SUITE 335 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381054625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012875182 | ||||||||
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| Practice Location | |||||||||
| Address1: | 848 ADAMS AVE | ||||||||
| Address2: | NEUROSCIENCE CLINIC - LOBBY LEVEL | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381032816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012875060 | ||||||||
| FaxNumber: | 9012874540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 10/18/2013 | ||||||||
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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 | 363LF0000X | 109329 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3497827 | 05 | TN | MEDICAID |