Provider Demographics
NPI:1629537410
Name:EAD, DOUGLAS PETER (FNP - C)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PETER
Last Name:EAD
Suffix:
Gender:M
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S LOCUST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4053
Mailing Address - Country:US
Mailing Address - Phone:931-762-4400
Mailing Address - Fax:931-762-4499
Practice Address - Street 1:6498 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:TN
Practice Address - Zip Code:38477-6384
Practice Address - Country:US
Practice Address - Phone:931-309-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily